Racer X Aquatics COVID-19 Screening
Racer X Aquatics COVID-19 Screening
First Name *
Last Name *
In the last 14 days, have you had a positive COVID-19 test? *
In the last 14 days, have you been in close contact with anyone who has tested positive? *
In the last 72 hours have you had close contact with someone diagnosed with COVID‐19? *
In the last 72 hours have you had close contact with who is under investigation or in quarantine for possible COVID‐19 infection? Close contact is defined as any individual who was within 6 feet of an infected person for at least 15 minutes. *
In the last three days have you had any of the following symptoms: *
In the last 24 hours, have you taken fever-reducing or other symptom-altering medicines due to COVID or COVID like symptoms (e.g. ibuprofen, Tylenol, or cough suppressants)? *
Do you currently have COVID-19, or are you caring for someone who has COVID-19? *
By checking below I certify that the responses provided above are true and accurate to the best of my knowledge and participation in this event is voluntary. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy