United Volleyball Health Assessment
This form must be submitted prior to attending practice.
Athlete’s Name *
Parent Email *
Team *
Date *
Has your child had any of the following symptoms in the past 14 days? Fever above 100.0, Cough, Shortness of breath or difficulty breathing, Chills, Muscle Pain, Headache, Sore Throat or loss of taste or smell? *
Has your child tested positive for Covid in the last 14 days? *
Has your child been in contact with anyone who has tested positive for Covid in the past 14 days" *
Has your child arrived from one of the states/territories listed on the New York State Mandatory Quarantine list in the past 14 days?https://coronavirus.health.ny.gov/covid-19-travel-advisory *
IF YOUR HAVE ANSWERED YES TO ANY OF THE ABOVE QUESTIONS, YOUR CHILD IS NOT PERMITTED TO ATTEND PRACTICE TODAY. Please reach out to your team's coach and the UNITED directors if you have answered YES to the questions above.
By submitting this form you are agreeing that have filled out the above information accurately and to the best of your knowledge. You are also giving UNITED VOLLEYBALL consent to document the daily health screening in agreement with The New York State Mandatory Covid Guidelines.
Please type your name below to serve as your digital signature, stating you have read and answered everything in the document. *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy