COVID Wellness Form
The following questionnaire must be completed daily prior to the participant taking part in any Cut Shot Program or session.  If you answer "YES" to any of the health screening questions below, the participant is NOT PERMITTED to attend the program for this day.

If you are attending a program, have not been fully vaccinated for Covid-19, and have traveled internationally or to any of the states beyond the immediate region (New York, Connecticut, Pennsylvania, and Delaware) you are NOT PERMITTED to attend a Cut Shot Volleyball Program until you have been back in the state for at least 7 days. Please see Travel Advisory Info for more details.

By signing this Covid-19 Temperature & Health Screening Questionaire you certify that you are the participant listed below (and over the age of 18), or you are the parent/guardian of the participant listed below (if the participant is a minor under age 18) with authority, knowledge, and understanding to complete and certify the contents of this Questionaire.
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Today's Date *
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Participant Full Name *
Parent or Guardian Name (if the participant is a minor)
Has the participant been fully vaccinated for Covid-19 (received their 2nd dose at least 14 days ago?) *
Has the participant had a fever of 100.4 degrees Fahrenheit or higher in the last 24 hours? *
Does the participant have any of the following symptoms: fever/chills, cough, shortness of breath, fatigue, loss of taste or smell, sore throat, muscle or body aches, vomiting or diarrhea, congestion or runny nose? *
Does the participant have any of the following symptoms: fever/chills, cough, shortness of breath, fatigue, loss of taste or smell, sore throat, muscle or body aches, vomiting or diarrhea, congestion or runny nose? *
Has the participant tested positive for COVID-19 within the last 10 days? *
I hereby certify that the above statements are true and correct to the best of my knowledge. *
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