Dyckman / Break 2 Build Basketball Skills Academy AAU Covid 19 Form

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COVID-19 QUESTIONNAIRE AND GENERAL CERTIFICATION –

Full Name

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I recognize that my ability to enter the building is conditioned upon my making the representations set forth in the Certification below and that I may be denied access if building staff believes, in its reasonable judgment, that I am exhibiting symptoms of COVID-19.

I have not tested positive for COVID-19 (or if I have tested positive, I have met CDC guidelines to end my isolation).

I have had no symptoms of COVID-19 for the last three days (e.g., cough, fever of 100.4 or greater, or shortness of breath).

I have not encountered anyone in the last two weeks who, to my knowledge, has tested positive for COVID-19, or who has shown symptoms of COVID-19.

By signing below, I certify that all 0the information above is true and accurate

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