COVID-19 Health Evaluation
In accordance with the Centers for Disease Control (CDC), Action Athletics is screening all participants for certain risk factors before entrance is allowed. Action Athletics may restrict entry based on responses in order to prevent the spread of COVID-19. Please fill out this form before your participation date. Form will not be vaild if not filled out at least 2 days prior to the participation date.
Participant's First Name *
Participant's Last Name *
Date of Participation *
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Participant has not had any contact with anyone who has been sick or had signs or symptoms of COVID-19 within 14 days. These symptoms include but are not limited to fever, cough, shortness of breath, sore throat, congestion, headache, muscle aches, nausea/vomiting/diarrhea, stomach aches, loss of smell or taste. *
Required
Participant has not had a fever above 99 in the past 14 days. *
Required
Participant has not had a cough in the past 14 days. *
Required
Participant has not had shortness of breath in the past 14 days. *
Required
Participant has not had a sore throat or congestion in the past 14 days. *
Required
Participant has not had a headache in the past 14 days. *
Required
Participant has not had muscle/joint pain in the past 14 days. *
Required
Participant has not had nausea/vomiting/diarrhea/stomach ache in the past 14 days. *
Required
Participant has not had loss of smell or taste in the past 14 days *
Required
Participant has not traveled to any country currently designated as a high-risk location by the CDC in the past 14 days. *
Required
Participant will submit to and pass a temperature check upon entry. *
Required
Parent or Guardian Signature *
Please type your name as your signature agreeing that the above information is accurate.
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