JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Summer COVID-19 Prescreen
Please meet ASPNC at the venue and check in with the VL when you arrive.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name- (full first name and first initial of last name)
*
Your answer
If you are accompanying a participant, please name the participant you are accompanying.
Your answer
What Program are coming for?
*
Disc Golf
Summer Hiking
Biking
Outdoor Climbing
Garden Buddies
Golf
Fly Fishing
Kayaking
Tennis
Required
Are you currently experiencing any of the following symptoms?
*
Fever, New or worsening cough, Shortness of breath, Lost sense of taste or smell, Nausea, vomiting, diarrhea, Sore throat, Other cold or flu like symptoms
Yes
No
Are you currently waiting for COVID-19 test results, or have you tested positive for COVID-19 in the last 30 days?
*
Yes
No
In the last 10 days, have you been in contact with anyone who has tested positive for Covid-19, are waiting for covid-19 test results, or exhibited any cold or flu like symptoms, such as fever or cough?
*
Yes
No
Is anyone in your household currently quarantining or isolating per CDC or Department of Public Health Guidelines?
*
Yes
No
Have you traveled outside of New England in the past 10 days?
*
New England includes: New Hampshire, Massachusetts, Vermont, Maine, Rhode Island and Connecticut.
Yes
No
If you answered yes to travel outside of New England are you fully vaccinated?
Yes
No
Clear selection
OPTIONAL: For those checking their temperatures at home, was your temperature above 100 degrees Fahrenheit?
Yes
No
Clear selection
By typing your name below, you agree that the above information is true.
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Adaptive Sports Partners.
Report Abuse
Forms
