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Marian Golf Screening form
Email address *
Name *
Have you had a cough in the last 24 hours *
Have you had shortness of breath in last 24 hours *
Have you had a sore throat in the last 24 hours *
Have you had a fever of over 100.3 in the last 24 hours *
Have you had close contact, or cared for someone with a confirmed case of COVID-19 in the last 24 hours? *
Emergency Contact Name
Emergency Contact Number
A copy of your responses will be emailed to the address you provided.
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