RHC COVID-19 Athlete/Coach Monitoring Form
Athlete Last Name
Athlete First Name
Level of Play
1. Do you have any of the following symptoms of COVID-19: Fever (100.0F or greater) 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? 2. Have you been in close contact with someone experiencing symptoms of COVID-19 AND/OR has tested positive for COVID-19 in the last 14 days? 3. Have you tested positive for COVID-19 in the last 14 days OR have been tested and are awaiting test results?
If your answer is "yes" to any of these questions, you may not enter the facility and must contact your coach or team manager right away. If you answer "no" to any of these questions, you may enter the facility.
NO to all questions
YES to one or more questions
I hereby certify that the athlete/coach listed above is symptom-free and will be entering the Rockford Park District facility. I certify that questions have been answered honestly and truthfully.
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