F2BF & Legacy Elite Health Form
If you have been exposed to a communicable disease, you may spread the disease to coaches, staff, or other gymnasts/parents in the facility. Therefore, prior to each class, we will be asking the following questions to reduce the chances of transmission and the spread of Covid-19.

PLEASE FLASH YOUR SCORE AT DROP OFF. THANK YOU.
Email address *
Have you, your child, or others accompanying you to todays class or other recent acquaintances tested positive for or been diagnosed as having Covid-19 or any other communicable disease? *
Have you, your child, or others accompanying you to todays class recently tested and are waiting on -results of a Covid-19 test? *
Have you, your child, or others accompanying you to todays class or other recent acquaintances/ classmates have: A Fever? (defined as above 100.4 degrees) *
Have you, your child, or others accompanying you to todays class or other recent acquaintances/ classmates have: Cough, shortness of breath, chills, sore throat, new loss of taste and/ or smell, nasal congestion, muscle ache, vomiting, diarrhea. (Any of the listed signs are automatic grounds for a 10 day quarantine) *
Has there been a positive exposure in your child or sibling's school that has caused ANY need for quarantine? *
Have you, your child, or others accompanying you to todays class traveled outside of NC in the past 10 days? Examples to include but not limited to: Work, Travel, Vacation, Competition, etc. https://www.mayoclinic.org/coronavirus-covid-19/map *
(If "YES") To what state? Travelers form must be filled out. Please SIGN IN https://www.legacyelitegym.com and go to Important Documents.
Have you, your child, or others accompanying you to todays class had contact with any out of State visitors? *
(If "YES") To what state? Travelers form must be filled out. Please SIGN IN https://www.legacyelitegym.com and go to Important Documents.
I understand that if the answer to any of these questions is "yes', I will be unable to participate in activities and refused entrance. A mandatory 10-21 day quarantine will need to take place before my gymnast returns to the gym depending on circumstance. "Hotspot" states are automatic refusal. *
Gymnast Name *
Date *
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Parents Name *
Relationship W/Gymnast (if Applicable) *
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