LebRec COVID-19 Screening
Please complete this COVID-19 screening for each LebRec participant/volunteer prior to each team session.
Participant/Volunteer Last Name *
Participant/Volunteer First Name *
Name of person completing this form. *
Sport and Division *
SYMPTOMS: Does participant/volunteer or their household members have any symptoms of COVID-19 or fever of 100 degrees or higher? 🤒🤧 *
CONTACT: Has participant/volunteer or their household members had any close contact with someone who is suspected or confirmed to have COVID-19 in the past 10 days? 🧍‍♀️🧍‍♂️ 📅 *
TRAVEL: Has participant/volunteer traveled in the past 10 days either internationally or by cruise ship? ✈🚌🚢 *
Do you give permission for the participant’s/volunteer’s temperature to be taken prior to each session? *
The information I have provided is true and accurate. *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of City of Lebanon. Report Abuse