Request edit access
COVID-19 Mandatory Symptom Check
Each participant (ex. manager/coach, athlete, umpire, spectator, or other volunteer) shall submit a mandatory symptom check prior to arriving at the field before every practice/game. This should be completed before leaving your home to travel to the practice/game. It should not be completed the day or night before.

If your team is using a team app with an integrated symptom check, you do not need to use this form. Use the team app instead.

All personnel shall stay home if they are diagnosed with COVID-19, if they had a known close contact, and/or if they are experiencing any signs of illness.
Email address *
Date of Practice/Game *
MM
/
DD
/
YYYY
First Name of Participant *
Last Name of Participant *
Full Name of Parent (if completing form for child)
Telephone *
Division *
Team Name (for umpires and visiting interlock teams, select the home team) *
Select the Participant's Role *
Has the participant listed above experienced any of the following symptoms within the last three days -- Fever or Chills; Cough; Shortness of Breath or Difficulty Breathing; Sore Throat; Fatigue; Muscle or Body Aches; Headache; Loss of Taste or Smell; Nausea, Diarrhea, or Vomiting? *
Captionless Image
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy