Pee Wee Soccer Thursday 2021 - Daily Health Screening
Please complete this form before 8:00am on the day of the program. We are taking these proactive steps to ensure everyone's health and safety. Please answer all of the questions. If you have any questions please call North Reading Parks & Recreation at 978-664-6016.

Anyone who answers "YES" or has symptoms to any of these questions cannot participate that day.
Email *
Participant First Name *
Participant Last Name *
Today or in the past 24 hours, has the participant or any household members had any of the following symptoms? *
In the past 10 days, has the participant had close contact with a person known to be infected with the novel coronavirus (COVID-19)? *
I as parent/caregiver am reporting all responses of the participant accurately. I understand that if any of the above answers are yes, my child will not be allowed to participate that day and therefore must stay/return home with their parent or caregiver. *
Parent/caregiver name filling out form. *
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