Elizabethtown Lacrosse Club Pre-practice/play Screening Form

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Elizabethtown Lacrosse Club's Pre-Practice/Play Screening
*NOT TO BE COMPLETED EARLIER THAN 1 HOUR BEFORE PRACTICE/GAME*

Email *

Player/Coach/Parent Name *

Affiliation *

12U

14U

Coach

Temperature *

In the last 7 days have you had any of the following symptoms? *

If at least 1 symptom, follow your school district's policy, CDC, and contact ELC at rheemsaa@lacrosse.com

Cough

Shortness of Breath

Difficulty Breathing

Fever

None of the Above

Required

In the last 7 days have you had at least 2 of these new symptoms? *

If at least 2 symptoms, follow your school district's policy, CDC, and contact ELC at rheemsaa@lacrosse.com

Shaking w/Chills

Muscle Pain

Headaches

Sore Throat

Loss of Taste or Smell

Dairrhea

None of the Above

Required

In the last 14 days have you been tested for Covid-19? *

Yes

Required

In the last 14 days have you been in personal contact with someone with suspected or confirmed Covid-19? *

Yes

Required

Your name below serves as an electronic signature and certifies that all information above is true and correct to the best of your knowledge. *

Submit

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