Fall COVID-19 Prescreen
Please meet ASPNC at the venue and check in with the VL when you arrive.
Name- (full first name and first initial of last name)
If you are accompanying a participant, please name the participant you are accompanying.
What Program are coming for?
Are you currently experiencing any of the following symptoms?
Fever, New or worsening cough, Shortness of breath, Lost sense of taste or smell, Nausea, vomiting, diarrhea, Sore throat, Other cold or flu like symptoms
Are you currently waiting for COVID-19 test results, or have you tested positive for COVID-19 in the last 30 days?
In the last 10 days, have you been in contact with anyone who has tested positive for Covid-19, are waiting for covid-19 test results, or exhibited any cold or flu like symptoms, such as fever or cough?
Is anyone in your household currently quarantining or isolating per CDC or Department of Public Health Guidelines?
By typing your name below, you agree that the above information is true.
Send me a copy of my responses.
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This form was created inside of Adaptive Sports Partners of the North Country.