TI Health Screening Form
First Name *
Last Name *
In the last 14 days has anyone in your household been in contact with someone who has tested positive for COVID-19? *
In the last 48 hours have you experienced any of the following symptoms? *
Required
In the last 10 days has anyone in your household spent more than 24 hours in a state which does not share a border with New York State? *
Are you a _________________? *
Athlete you are here for ________________________. *
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