Bethesda Premier Cup COVID-19 Pre-Screen Questionnaire
In order to better maintain the safety of all members of the Premier Cup Community we are asking that all players take the following Pre-Screen Questionnaire before each game.

Sign in to Google to save your progress. Learn more
Full Team Name (FC Bucks Green 2009, Bethesda Blue 2008, etc.) *
Age Group *
Does any member of your team have a temperature of or about 100.4? *
In the last 14 days has any member of your team had any of the following symptoms? Please check all that apply. *
In the last 14 days, has your any member of your team been waiting for a COVID-19 test result, been diagnosed with COVID-19, or been instructed by any health care provider to isolate or quarantine? *
In the last 14 days, has any member of your team had close contact (within 6 feet for at least 15 minutes) with anyone diagnosed with COVID-19 or suspected of having COVID-19 (i.e. tested due to symptoms)? *
Our team agrees to follow all social distancing rules as stipulated by the Premier Cup organizers. *
Name of COVID-19 Manager this Form (First and Last Name) *
Today's Date (DO NOT put your Date of Birth) *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy