Box Elder Pre-Participation Questionaire

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

It is important for the safety of everyone that these questions are answered honestly. Please do not attend any workout, practice, or competition if you answer "yes" to any of the following questions. This form filled out and submitted is required before any participation. Coaches will make sure the form has been recieved before you will be admitted. Parents please do not leave your athlete until you have recieved confirmation that your athelte is cleared to participate.

What's your first name? *

What is your last name? *

What is today's date? *

YYYY

In the last 72 hour have you had a fever over 100.4 or above? *

Yes

In the last 72 hours have you had a new undiagnosed cough? *

Yes

In the last 72 hours have you experienced a sore throat ? *

Yes

In the last 72 hours have you experienced shortness of breath or trouble breathing? *

Yes

In the last 72 hours have you experienced a sudden change in taste or smell? *

Yes

In the last 72 hours have you exprienced muscle aches or pains? (not assiociated with physical activity) *

Yes

Is there anyone in your home that is experiencing any of the above symptoms? *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms