JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Harding University Volleyball Camp COVID-19 Screening Form
Please complete this form within 48 hrs of the clinic. If you check "yes" to any box, please stay home. Please fill out this form prior to each clinic you attend. Thank you!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name
Your answer
Cell Phone Number
Your answer
Have you been within 6 feet of a person with a lab-confirmed case of COVID-19 for at least 5 minutes, or had direct contact with their mucus or saliva, in the past 14 days?
*
Yes
No
In the last 48 hours, have you had any of the following NEW symptoms? Fever of 100+, cough, trouble breathing or shortness of breath, muscle aches, sore throat, loss of smell or taste, nausea, vomiting, diarrhea, or headache
*
Yes
No
Have you been asked by a medical or school official to stay home from school due to a close contact quarantine?
*
Yes
No
I acknowledge that volleyball is considered a "close contact" sport and there is potential for the spread of COVID-19. I agree to take full responsibility and liability in the event of contracting COVID-19 through participation in volleyball.
Agree
Disagree
Clear selection
If you answered "Yes" to any of these questions, please stay home. Thank you!
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Harding University.
Report Abuse
Forms
