Western Maryland Chapter of US Lacrosse Covid Screening for Participants.
Girls High School League Spring 2021
Email address *
Date of Activity you are participating in? *
Location of Activity? *
First Name *
Last Name *
Current Grade *
Current School *
Phone Number *
Have you experienced any of the following symptoms in the past 48 hours: *
Please select all that apply.
Required
Current Temperature Reading? *
Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who is known to have laboratory-confirmed COVID-19 or anyone who has any symptoms consistent with COVID-19? *
Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who has any symptoms consistent with COVID-19? *
Are you isolating or quarantining because you may have been exposed to a person withCOVID-19 or are worried that you may be sick with COVID-19 or a positive COVID-19 test? *
Are you currently waiting on the results of a COVID-19 test? *
A copy of your responses will be emailed to the address you provided.
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