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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. 

Have you been diagnosed with Coronavirus (COVID-19)? *
Answer required for "Have you been diagnosed with Coronavirus (COVID-19)? "
If diagnosed with Coronavirus (COVID-19), were you symptomatic?*
Answer required for "If diagnosed with Coronavirus (COVID-19), were you symptomatic?"
If diagnosed with Coronavirus (COVID-19), were you hospitalized?*
Answer required for "If diagnosed with Coronavirus (COVID-19), were you hospitalized?"
Has any member of your household been diagnosed with Coronavirus (COVID-19)?*
Answer required for "Has any member of your household been diagnosed with Coronavirus (COVID-19)?"
Do you have pre-existing medical conditions and/or are you immunocompromised (e.g., diabetes, asthma, auto-immune disorders, etc.)?*
Answer required for "Do you have pre-existing medical conditions and/or are you immunocompromised (e.g., diabetes, asthma, auto-immune disorders, etc.)?"
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 for "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. "