Bedford Eagles Wellness Survey
Your health and safety and the wellbeing of your families are of upmost priority to Bedford Minor Basketball Club. Each training day all athletes are required to submit a short survey attesting to their current wellness and potential exposure to Covid-19.  Please review and submit this form before you come to any training sessions. If you answer "yes" to any of these questions PLEASE do not attend the training session that day.  If you answer "no" to all question please proceed to the training session.

In the event you test positive for Covid-19 please notify us immediately so we can do contact tracing and notify anyone who may be affected or had close contact with you.  Also AT ANY TIME during a session if you begin to feel unwell at all, please let the coach know immediately.
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Email *
Athletes Name *
Parents Name *
In the last 14 days, have you or anyone you've had close contact with experienced any of the following symptoms?                                                                                    * Fever of 100.4 degrees Fahrenheit / 38 degrees Celsius or great; * Cough or shortness of breath;   * Diarrhea, stomach pain or abnormal loss of appetite                                                                                                                              * Extreme fatigue or muscle aches;  * Chills with or without shaking;   * Loss of taste or smell                                                                               *
In the last 14 days, have you or anyone you've had close contact with tested positive or been diagnosed by a healthcare provider with Covid-19 *
In the last 14 days, have you or anyone you've had close contact with been instructed to self-quarantine by a healthcare provider? *
In the last 14 days, to your knowledge, did you or anyone you've had close contact with have close contact with a confirmed or probable case of Covid-19 infection?  Close contact is defined as:  being within approximately 6 feet(2 meters) or having direct contact with secretions of a Covid-19 case(being coughed on). *
A copy of your responses will be emailed to the address you provided.
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