Green Brook Baseball Club Player (and Staff) COVID-19 Daily Participation Screening
Dear GBBC Parents,

This health questionnaire must be completed 2 hours prior to each practice or game as required by the New Jersey Department of Health and the Green Brook Baseball Club Program Participation Plan.

This form must be completed for each player, manager, coach and team parent that is participating, coaching or assigned to assist practices or games.

Thank you for your cooperation.

Email address *
First Name of Player (Manager, Coach or Team Parent) *
Last Name of Player (Manager, Coach or Team Parent) *
Team Name *
Team Manager Last Name *
Does the Player (Manager, Coach or Team Parent) have a fever of 100.4 or higher? *
Has the Player (Manager, Coach or Team Parent) been administered any fever reducing medication? *
Does the Player (Manager, Coach or Team Parent) have any of the following symptoms (Fever, Cough, Shortness of Breath)? *
Do any household members of the Player (Manager, Coach or Team Parent) have any of the following symptoms (Fever, Cough, Shortness of Breath)? *
Name of Parent/Guardian (Manager, Coach or Team Parent) submitting this form *
Signature *
Required
Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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