COVID Screening Questions
This information is required for entry into the Panther Rugby Academy training area at - You only need to fill this form out on the first entry into the camp area. This form must be submitted, no more than 4 hours, before your arrival.
If you answer YES to any of these questions please do not enter the training area, so we can limit the spread of COVID19 to others and keep having rugby events! Thank you for your cooperation!
Name *
Have you/your player been told to quarantine/isolate by a medical provider or the health department? *
Are you currently awaiting COVID-19 test results? *
Are you/your player experiencing a cough, shortness of breath, or difficulty breathing which is new or not explained by a pre-existing condition? *
In the last 48 hours, have you/your player had at least two of the following new symptoms: Fever, Chills, Repeated shaking chills, Muscle pain, Headache, Sore throat, Vomiting, Diarrhea or Loss of taste or smell? *
Was you/your player's temperature 100.4 or above yesterday and/or today? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy