Green Brook Baseball Club Player (and Staff) COVID-19 Daily Participation Screening
Dear GBBC Parents,

This health questionnaire must be completed 2 hours prior to each practice or game as required by the New Jersey Department of Health and the Green Brook Baseball Club Program Participation Plan.  

This form must be completed for each player, manager, coach and team parent that is participating, coaching or assigned to assist practices or games.

Thank you for your cooperation.


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Email *
First Name of Player (Manager, Coach or Team Parent) *
Last Name of Player (Manager, Coach or Team Parent) *
Team Name *
Team Manager Last Name *
Has the Player (Manager, Coach or Team Parent) had a fever of 100.4 or higher in the past 14 days? *
Has the Player (Manager, Coach or Team Parent) received a positive result from a COVID-19 test within the past 14 days? *
In the past 14 days, has the Player (Manager, Coach or Team Parent) had any of the following symptoms not attributed to another health condition:     (Cough, Loss of Smell or Taste, Runny Nose, Shortness of Breath, Sore Throat) *
Has the Player (Manager, Coach or Team Parent) been in contact with anyone who had COVID-19 or symptoms of COVID-19 in the past 14 days? *
In the past 14 days, has the Player (Manager, Coach or Team Parent), or someone they have been in contact with, traveled outside New Jersey to a location with restrictions (including travel restrictions) due to COVID-19? *
Name of Parent/Guardian (Manager, Coach or Team Parent) submitting this form *
Signature *
Required
Date *
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A copy of your responses will be emailed to the address you provided.
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