Iroquois Middle School COVID-19 Girls Volleyball Monitoring Form

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Email *

Player First Name *

Player Last Name *

Sport *

Volleyball

What grade are you in? *

7th grade

8th grade

Have you had a new or unusual cough in the last 24 hours? *

Yes

Have you had a sore throat in the last 24 hours? *

Yes

Have you had diarrhea in the last 24 hours? *

Yes

Have you had any flu like symptoms (body aches, chills, extreme fatigue) *

Yes

Have you been experiencing any recent loss of taste or smell? *

Yes

Have you had shortness of breath in the last 24 hours? *

Yes

Have you had a fever of 100.3 or higher in the last 24 hours? *

Yes

Have you had close contact or cared for someone with a confirmed case of COVID-19 in the last 14 days and without a face covering? *

Yes

You will be required to bring your own water and have enough for yourself for the duration of your workout. Will you be bringing enough water/gatorade/powerade to stay hydrated? *

Yes

Mask will be required for entering and exiting facilities as well as during non high intensity cardio workouts. Please make sure you bring and wear a face covering. Do you acknowledge? *

Yes

Emergency Contact (Name) *

Emergency Contact (Phone Number) *

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