USAWM SOUTH health screening form
To prevent the spread of COVID-19 and reduce the potential risk of exposure to our athletes,
coaches, officials, visitors, staff, and volunteers, we are conducting a simple screening
questionnaire. Your participation is important to help us take precautionary measures to protect
you and everyone in the practice facility. Thank you for your time.

Please fill this form out within 24 hours of your scheduled practice.
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Practice Date
First Name
Last Name
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Phone Number
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