COVID-19 Athlete Self-Check Form
The Woodstock Dolphins Coaches and Board of Directors are dedicated to ensuring the safety of all of our athletes and families. As such, during the COVID-19 pandemic it is important to understand when your swimmer should not be coming into practice. This form will be used to assess your swimmer's health daily to determine his/her ability to safely continue practicing.

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Name* (Last, First) *
Contact* (Phone or Email) *
Swimmer practice level
Please answer yes or no if your swimmer(s) have had any combination of the following symptoms: Fever (100.4 or higher), dry consistent cough, shortness of breath/difficulty breathing, congestion/runny nose, diarrhea (not due to a preexisting condition), muscle pain, repeated shaking or chills, sore throat, loss of sense of taste or smell, unusual continuous headache lasting for more than 48 hours, *
In the past 14 days, have you been in close physical contact, sustained communication face-to-face for 2-3 minutes or direct physical contact, within 6 feet for 2-3 minutes with someone displaying any of the following COVID-19 symptoms?  Fever (100.4 or higher), Dry Consistent Cough, Shortness of breath / difficulty breathing, Congestion or runny nose, Diarrhea, Muscle pain / repeated shaking with chills, Sore throat / loss of sense of taste and/or smell? *
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