Pop Up Tennis Kids Health Screening
Please help us keep everyone safe by completing the health screening below for each person entering the gym.
Name of Person Entering Gym
Do you currently have any of these symptoms? Please check all that apply.
Fever or chills
Shortness of breath
New loss of taste or smell
Have you had a positive COVID-19 test in the last 10 days?
Have you or someone you live with been in close contact with someone who has a confirmed or suspected COVID-19 diagnosis in the past 10 days?
Have you been mandated or advised by a government agency, physician or school to isolate or self-quarantine?
Traveled in the past 2 weeks? Stayed home? Please choose the response that best matches your situation below.
I have traveled and followed NY State guidelines for returning to NY safely and with the appropriate testing.
I have traveled and am awaiting clearance from tests taken.
I have not traveled.
Please certify that the above information is true by noting the first and last name of the person completing this form.
Send me a copy of my responses.
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