Covid-19 Questionnaire for Coaches/Staff

Masthead

Covid-19 Questionnaire for Coaches/Staff

To participate in workouts during the summer recess period, the parent/guardian must complete this form. This form only needs to be completed one time.

Last Name*

Answer Required

First Name*

Answer Required

Sport*

Answer Required

Cell phone number

Answer Required

Have you been diagnosed with Coronavirus (COVID-19)? *

Answer Required

Yes

If diagnosed with Coronavirus (COVID-19), were you symptomatic?*

Answer Required

Yes

Not Applicable

If diagnosed with Coronavirus (COVID-19), were you hospitalized?*

Answer Required

Yes

Not Applicable

Has any member of your household been diagnosed with Coronavirus (COVID-19)?*

Answer Required

Yes

Do you have pre-existing medical conditions and/or are you immunocompromised (e.g., diabetes, asthma, auto-immune disorders, etc.)?*

Answer Required

Yes

If yes, describe in detail

Answer Required

By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. *

Answer Required

I accept

Please fix the highlighted areas below before submitting.

Covid-19 Questionnaire for Coaches/Staff

Covid-19 Questionnaire for Coaches/Staff