Covid19 Health Form

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Covid19 Health Form

Required WEEKLY(Monday) online wellness survey for swimmers, staff and volunteers. This form must be completed before entering the facility. Entrance to the facility will not be permitted without the completed form.
* Required

Email *

Last Name *

First Name *

Do you feel well today? *

Yes

Have you felt sick in the past 24 hours? *

Yes

Are you currently experiencing any of the following symptoms? (Please check options that apply) *

Fever

Difficulty breathing

Chest pain

Sore throat

Chills

Runny nose

Sneezing Coughing

Headache

Abnormal muscle aches

Gastro illness

Loss of smell

Loss of taste

None of the above

Required

Have you been in contact with anyone who has traveled outside of USA within the past 14 days? *

Yes

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