Covid-19 Screening Questionnaire
The safety of the volunteers, coaches, participants and family members of the Roundabout Runners Club is our overriding priority. To prevent the spread of the coronavirus and reduce the potential risk of exposure, we are asking every parent to complete and submit this questionnaire prior to their child or children taking part at each practice or meet. You must complete this form each week on Sunday or Monday. Your child may not participate in Roundabout Runners Club events during a given week unless this form is completed before Monday's practice each week.

Please respond to each of the following questions truthfully and to the best of your ability on behalf of your runner(s). Your participation is important to help us take precautionary measures to protect you and others involved in our programs.
Email address *
Cell Phone Number *
Answer the following questions on behalf of members of your family participating in club activities. List the participant names (first and last) below: *
1. Are you currently experiencing or have you experienced in the past 14 days, any of the following symptoms?Fever (100.4 degrees Fahrenheit/ 37.8 degrees Celsius or greater as measured by an oral thermometer)? *
Are you currently experiencing the following? Cough, Shortness of breath or difficulty breathing, sore throat, new loss of taste or smell, chills, head or muscle aches *
2. In the past 14 days, have you been in close proximity to anyone who was experiencing any of the above symptoms or has experienced any of the above symptoms since your contact? *
3. In the past 14 days, have you been in close proximity to anyone who has tested positive for COVID-19? *
4. Have you been tested for COVID-19 and are waiting to receive test results? *
5. Have you tested positive for COVID-19, or are you presumptively positive for COVID-19 based on your health care provider's assessment or your symptoms? *
NOTE: If you have tested positive for COVID-19 or have been presumptively positive for COVID-19 based on your health care provider’s assessment or your symptoms, please contact the program coordinator when: (1) you have had no fever for at least 72 hours (3 full days), without the use of fever-reducing medications; (2) your other symptoms have improved; and at least 7 days have elapsed since your symptoms first appeared.
CERTIFICATION I HEREBY CERTIFY THAT RESPONSES PROVIDED ABOVE ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. By typing your name below, you are providing your digital signature. Your IP address and user agent will be submitted with the form. Note: The information collected on this form will be used to determine only whether you may be infected with COVID-19. The information on this form will be maintained as confidential. Any questions should be directed to the program coordinator. Sign Here: *
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