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COVID-19 Questionnaire
Please answers these questions while seated!
Thank you, OMMA staff.
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* Required
Email
*
Your email
First & Last Name
*
Your answer
Child or Children's First & Last Name
Your answer
Which Class Are You In? (if parent, please choose which class your child is in)
Kids MMA - White/ Yellow/ Orange (7-10)
Kids MMA - Green + (7-10)
Teen MMA - White/ Yellow/ Orange (11-14)
Teen MMA - Green + (11-14)
Adult Kickboxing
Clear selection
1. Have you experienced any of the following symptoms in the last 14 days OR tested positive for COVID-19?(Please mark all symptoms that apply)
*
Fever
Cough
Shortness of Breath/ Difficulty Breathing
Sore Throat
Chills
Muscle Pains
New Loss of Taste or Smell
No, I have not have any of these symptoms or been tested positive for COVID-19
Required
2. Have you been in contact with someone who has experienced any of the symptoms listed in question 1 in the last 14 days OR anyone who tested positive for COVID-19?
*
Yes, I have been in contact with someone with these symptoms or someone who had a positive diagnosis.
No, I have not been in contact with anyone with these symptoms.
3. Have you or someone have been in contact with a travelled state that has a significant spread of COVID-19 in the last 14 days?
*
Yes, I have travelled to a state that has a significant spread of COVID-19 in the last 14 days.
No, I haven't travelled state that has a significate spread of COVID-19 in the last 14 days.
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