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Health Screening Assessment
To reduce illness in the league, we ask that you check on the health of your child daily and complete this form prior to arriving to the program.
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Participant's Name
*
Your answer
Below is a list of common COVID-19 symptoms. Is your child expressing any of those symptoms below?
*
Cough
Shortness of breath or difficulty breathing
Fever
Chills
Muscle pain
Sore throat
New loss of taste or smell
Nausea
Vomiting
Diarrhea
Skin rash
Redness of eyes
Loss of appetite
Fatigue
Abdominal pain
None of the Above
Other:
Required
My child has experienced any COVID-19 symptons in the past 14 days
*
Yes
No
Required
My child has tested positive for COVID-19 in the past 10 days
*
Yes
No
Required
My child has had close or proximate contact with confirmed or suspected COVID-19 case in the past 10 days
*
Yes
No
Required
My child has traveled internationally within the past 10 days.
*
Yes
No
Required
Temperature at home
Your answer
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