Parkway North Athletic Screening Form
If the answer to any of the below questions is yes, other than the travel question, then the athlete will not be allowed to participate until a follow up with our trainer and/or proper documentation have been provided of a negative COVID-19 test or other circumstances.
Email address *
Last Name *
First Name *
Emergency Contact Phone # *
Emergency Contact Name *
Today's Date *
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Which activity are you attending? *
In the past 24 hrs have you had runny nose/congestion different than seasonal allergies * *
In the past 24 hrs have you had a fever over 100 degrees? *
In the past 24 hrs have you had a new or worsening cough? *
In the past 24 hrs have you had a sore throat different than allergies? *
In the past 24 hrs have you had shortness of breath or difficulty breathing? *
In the past 24 hrs have you had new loss of taste or smell? *
In the past 24 hrs have you had diarrhea or vomiting? *
Within the last 14 days have you been in direct contact (Less than 6 feet apart, No mask, and for longer than 15 Minutes) with a person with a confirmed case. *
Have you traveled outside the country in the past 14 days? *
DO NOT HIT SUBMIT UNTIL TOLD TO DO SO BY YOUR COACH
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