Health Screen Survey | 18U 2003 Boys
Please complete the questions below the morning of the your event. No candidate will be able to participate without having completed the Symptom Pre-Screen. All questions will be recorded/kept confidential. If an answer to any question is "yes", please stay home.
* Required
Participant Name
*
Your answer
Are you attending practice?
*
Yes
No
Arriving late
Leaving early
Tryout Shirt Color
*
Choose
Orange
Navy
White
Tryout Shirt Number
*
Your answer
Is anyone in the household (player, parents, siblings, etc) feeling sick? (symptoms could include Fever or chills, Cough, Shortness of breath or difficulty breathing, Fatigue, Muscle or body aches, Headache, New loss of taste or smell, Sore throat, Congestion or runny nose, Nausea or vomiting, Diarrhea, etc.)
*
NO
YES
Has anyone in your family been exposed to a COVID-19 positive individual or a suspected COVID-19 positive individual in the last 14 days?
*
NO
YES
Have you traveled in the last 14 days to an area with travel restrictions, as identified by the PA Department of Health or the Centers for Disease Control and Prevention? (Alabama, Arizona, Arkansas, California, Florida, Georgia, Idaho, Kansas, Louisiana, Mississippi, Missouri, Nevada, North Dakota, Oklahoma, South Carolina, Tennessee, Texas)
*
NO
YES
Person Filling Out Form
*
Your answer
Relation to Participant
*
Your answer
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