Symptoms Survey - Return to Play Form - WCEUA
Program *
First and last name *
Graduation Year *
Branch *
Have you had fever-like symptoms in the last seven days? *
Have you had an unexpected repeated cough in the last seven days? *
Have you had repeated diarrhea in the last seven days? *
Have you had chills in the last seven days? *
Have you had any contact with anyone who has tested positive for Covid 19 in last 7 days? *
Have you had unexpected shortness of breath in the last seven days? *
Have you experienced unexpected weakness or fatigue in the last seven days? *
Have you experienced unexpected extreme loss of appetite in the last seven days? *
I agree to the following: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; *
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