Pride Returning to Play Health Screening

Thank you for helping keep your Pride Family healthy and safe!

This form must be completed before your player attends practice or game for that day (i.e. Player has practice on Tuesday, form must be completed Tuesday OR Player has a tournament on Saturday and Sunday you must complete this form for your player on both Saturday and Sunday)

If you have answered yes to any of the above questions, please contact Coach Tate or Stephanie Hood, Midwest Pride Board President at President@midwestpridebaseball.org immediately. Your return to Pride Activities must be determined by Coach Tate and the Midwest Pride Baseball Board President.
By typing your name below, you attest that the information you have provided is accurate to the best of your knowledge. (Please type in first and last name of the parent / coach completing the form). *
Date *
MM
/
DD
/
YYYY
Player's First Name *
Player's Last Name *
Current Temperature (If Temp is over 100 degrees player or coach is not allowed to attend practice / game and you need to call Coach Tate to discuss next step) *
What team are you on? *
Are you or anyone your home currently showing symptoms of Influenza/Flu or COVID-19 including 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? *
Are you or anyone your home currently showing symptoms any other contagious illnesses *
Is anyone in the player's household waiting on COVID-19 test result? *
Have you / your player previously tested positive for COVID-19? *
Are you / or player caring or anyone in your household caring for someone who have tested positive with COVID-19 (friends, family members, co-workers, etc)? *
Have you / or player had close contact with others who have tested positive with COVID-19 or been exposed to someone that tested positive for COVID or displaying symptoms of COVID/ respiratory illness in the past 14 days (friends, family members, co-workers, etc). *
In the last 30 days, have you or anyone in your household: *
YES - DO NOT ATTEND PRIDE FUNCTION AND CALL COACH TATE TO DISCUSS NEXT STEPS
NO
traveled to a foreign country with a level 2, 3, or 4 travel advisory by the US State Department?
been on a cruise?
visited state or cities with known widespread transmission of COVID-19?
Thank you for helping to ensure your PRIDE Family remain healthy and safe.
If you have answered yes to any of the above questions, please contract Coach Tate or Stephanie Hood, Midwest Pride Board President at President@midwestpridebaseball.org immediately. Your return to Pride Activities must be determined by Coach Tate and the Midwest Pride Baseball Board President.
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