PVS 2021 SC Champs - Wave III Health Check, Freedom Center (Athletes)
Please complete this form NO EARLIER THAN 4 hours of arriving at the pool. If you answer yes to any of the following questions, do not come to the pool.  The form may be completed by the swimmer or swimmer's parent or guardian.

Please provide an email address to be used in case of contact tracing.
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Email *
Last Name *
Please enter the swimmer's last name
First Name *
Please enter the swimmer's first name
Club *
Session *
In the past 24 hours, have you had any of the following: *
Yes
No
A new fever (100.4 or higher) or a sense of having a fever?
Taken medication to reduce a fever?
A new cough that you cannot attribute to another heath condition?
New shortness of breath that you cannot attribute to another health condition?
A new sore throat that you cannot attribute to another health condition?
New muscle aches (myalgia) that you cannot attribute to another health condition or that may have been caused by a specific activity (such as physical exercise)?
A new onset of loss of sense of taste or smell?
Nausea or vomiting?
Diarrhea?
Congestion or runny nose?
Have you been around someone who is sick?
Have you been around someone who has tested positive for COVID-19?
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