LVSC COVID-19 Health Screening

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This is a Daily Screening for Lenape Valley Soccer Club Players.
If you are from another club, please complete our Visiting Team form instead, at https://forms.gle/BijQ5WEmrSJZEVZq5.

Please type child’s first and last name *

What Team does your child play on? *

Please Enter today's date. *

YYYY

Was the player's temperature over 100.4 degrees Fahrenheit today? *

Yes

Has the player tested positive for COVID-19 within the last 14 days? *

Yes

Does the player have any of the following symptoms; Fever or Chills, Cough, Shortness of Breath or Difficulty Breathing, Fatigue, Atypical Muscle Pain or Body Aches, Headache, New Loss of Taste or Smell, Sore Throat, Congestion or Runny Nose, Nausea or Vomiting, and/or Diarrhea? *

Yes

Within the past 14 days, has the player traveled outside of the United States OR visited any of the states on the New Jersey Travel Advisory List (https://covid19.nj.gov/faqs/nj-information/travel-and-transportation/which-states-are-on-the-travel-advisory-list-are-there-travel-restrictions-to-or-from-new-jersey) *

Yes

Within the last 14 days, has anyone in the player's household been exposed to, or come into contact with, anyone you know: (a) who has COVID-19, (b) who is/was being tested for COVID-19, (c) who had symptoms consistent with COVID-19, or (d) who was exposed to someone with COVID-19? *

Yes

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