Soccer Camp COVID-19 Health Screening
Participants, coaches, staff and officials should stay home if they present any viral symptoms. A health screening will be conducted upon arrival of all staff, participants and volunteers. This information will be maintained by the Totowa PAL as a private medical record.
Today's Date *
MM
/
DD
/
YYYY
Player First & Last Name *
Have you been in close contact with a confirmed case of COVID-19 in the past 14 days OR have you been asked to quarantine in the last 14 days? *
Are you experiencing a cough, shortness of breath or sore throat? *
Have you had a fever in the last 48 hours? *
Have you had a loss of taste or smell? *
Do you have abdominal pain, nausea, vomiting or diarrhea? *
Do you have a fever at or above 100.3 degrees Fahrenheit? *
If yes, what is your temperature (in deg Fahrenheit)?
Submit
Never submit passwords through Google Forms.
This form was created inside of Totowa PAL. Report Abuse