Covid 19 -Pre-Screen
To protect our members and keep our communities healthy and safe, participants at all BYA gatherings
(team meetings, activities, training, games, etc.) are required to meet health requirements, wear a
face-covering/mask, wash hands and use social distancing. Please review the statements below and sign
the form to verify participant meets all health requirements.
This will need to be filled out prior to all practices and games.
Email *
Child(rens) Name *
My child/or I have not experienced any of the following symptoms in the last 14 days.*Fever * Muscle Pain *Cough*Cough *New loss of Taste or Smell * Nausea *Chills*Sore Throat *Diarrhea *Headache*Shortness of breath or difficulty breathing (not caused by a pre-existing condition such as asthma) *
My child has not had a fever over 100 degrees, without the use of fever-reducing medications, within thelast 72 hours. *
My child has not had any known exposure to COVID-19 or been in close contact with anyone that hastested positive in the last 14 days. *
My child has not traveled outside of Pennsylvania to any states listed on the PA Department of Health’swebsite in the past 14 days. *
We will pre-screen the participant and any family members before attending any BYA event. If the answerwas Yes to any of the above questions, the individual will not be allowed to participate in that event.As with any social activity, use of BYA facilities or services, or participation in BYA programs, may presentthe risk of contracting COVID-19. While BYA takes safety and preventative precautions, BYA can in no way warrant that COVID-19 infection will not occur through the use of such facilities or services or participationin BYA programs. *
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