1st Grade Rumson Rec - Girls Lacrosse COVID-19 Screening
This form is to be completed daily for each player participating in Rumson Rec Girls Lacrosse practices and games.

Any of the symptoms below could indicate a COVID-19 infection and may put your child at risk for spreading illness to others.

Please complete all questions and submit prior to arriving to each scheduled event this season. Questions? Email Choffmann@rumsonnj.gov or Epaonehurd@rumsonnj.gov
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Today's Date *
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Parent/Guardian Email Address *
Please Type Your Child's Full Name (Last Name, First Name) *
Last Name, First Name
Please Select Your Child's Team *
SYMPTOMS Section A - If TWO OR MORE of the symptoms in this Section are checked off, please keep your child home and notify the Rumson Recreation department for further instructions. *
必填
SYMPTOMS Section B - If AT LEAST ONE symptom in this Section is checked off, please keep your child home and the Rumson Recreation department for further instructions. * *
必填
CLOSE CONTACT/POTENTIAL EXPOSURE - If ANY of the 'Close Contact/Potential Exposure' statuses are checked off, your child should remain home for 14 days from the last date of exposure (if child is a close contact of a confirmed Covid-19 case) or date of return to New Jersey. Please use these links: http://bit.ly/NJTravAdv and https://bit.ly/IntlTravAdv to visit the current State of NJ and International Travel Advisory / Travel Restriction lists if needed to answer the questions below. The safest option is to stay home for 14 days. If you cannot stay home for 14 days due to economic or other hardship, there are two options:• No Test Option: Stay home for 10 days. If you stay symptom free for 10 days, quarantine ends. Monitor symptoms, wear a mask, and social distance through day 14.• Test Option: Stay home for 7 days. Get tested at Day 5, 6, or 7. Stay home while awaiting results. If the test is negative and you stay symptom free, quarantine ends. Monitor symptoms, wear a mask, and social distance through day 14. Please verify if : * *
必填
VERIFICATION - Select 'Yes' in the dropdown to verify that all information on this form is correct to the best of your knowledge * *
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