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COVID-19 Screening- Cheer
Please answer and submit form before entering weight room or practice
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Sport/Team
*
Choose
Varsity
JV
In the last 24 hours have you experienced a fever greater than 100 degrees?
*
Yes
No
In the last 24 hours have you experienced a new or worsening cough?
*
Yes
No
In the last 24 hours have you experienced shortness of breath or trouble breathing?
*
Yes
No
In the last 24 hours have you experienced a sore throat? (Different from seasonal allergies)
*
Yes
No
In the last 24 hours have you experienced loss of taste or smell?
*
Yes
No
In the last 24 hours have you experienced any diarrhea or vomiting?
*
Yes
No
In the last 24 hours have you experienced a runny nose or congestion different from seasonal allergies?
*
Yes
No
Do you have a household member or close contact that has been diagnosed with COVID-19 in the past 2 weeks?
*
Yes
No
By selecting the box below you are acknowledging that you have honestly answered all questions above. If any questions were answered YES, please alert your coach for a temperature check at this time.
*
I Understand and Agree
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