3rd & 4th GRADE - 2021 Cranford Lacrosse Club - COVID-19

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3rd & 4th GRADE - 2021 Cranford Lacrosse Club - COVID-19 - Questionnaire

PLAYER'S NAME *

TODAY'S DATE *

YYYY

QUESTION #1: SYMPTOMS - HAVE YOU HAD ANY OF THE FOLLOWING IN THE LAST 24 HOURS? CHECK ALL THAT APPLY: IF ANY SYMPTOM IS CHECKED, PARTICIPANT IS NOT ALLOWED TO ATTEND PRACTICE. IF SYMPTOM PERSISTS, PLEASE SEE A DOCTOR. IF YOU CHECK "NONE" THEN YOU CAN PARTICIPATE. *

Fever

Chills

Muscle Aches

Headache

Sore Throat

Nausea or Vomiting

Diarrhea

Fatigue

Congestion or Runny nose

Persistent Cough

Shortness of Breath

Difficulty Breathing

Loss of Smell

Loss of Taste

NONE

Required

QUESTION #2: EXPOSURE - HAS THE PARTICIPANT HAD CLOSE CONTACT WITH A PERSON WITH CONFIRMED COVID-19 IN THE LAST 14 DAYS? IF THE ANSWER IS "YES", THE PARTICIPANT IS REQUIRED TO FOLLOW PROTOCOL OF QUARANTINE FOR A PERIOD OF 10 DAYS, OR 7 DAYS WITH A NEGATIVE COVID-19 TEST. *

Yes

Required

QUESTION #3: TEMPERATURE CHECK - YOU ARE RESPONSIBLE FOR TAKING THE TEMPERATURE OF YOUR PLAYER AND ARE ATTESTING THAT THEIR TEMPERATURE DOES NOT EXCEED 100.3 DEGREES. IF YOU ANSWER "NO", THEN THEY DO NOT HAVE A TEMPERATURE EXCEEDING 100.3 DEGREES AND CAN PARTICIPATE. *

Yes

QUESTION #4: OUT OF STATE TRAVEL - HAS THE PARTICIPANT TRAVELED OUT OF STATE? IF THE ANSWER IS "YES" THE PARTICIPANT IS REQUIRED TO FOLLOW PROTOCOL AND QUARANTINE FOR A PERIOD OF 10 DAYS OR 7 DAYS WITH A NEGATIVE COVID -19 TEST AND THEREFORE NOT ALLOWED TO PARTICIPATE. IF THE ANSWER IS "NO", THE PARTICIPANT MAY ATTEND THE PRACTICE OR GAME. *

Yes

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