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FAQ
Date
*
Athlete Name
*
First
Last
Phone
*
Email
*
Have you traveled internationally or have been in close contact with anyone who has traveled internationally within the last 14 days?
*
Yes
No
Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?
*
Yes
No
Have you been directed to self-quarantine, or have had contact with anyone who has been directed to do so.
*
Yes
No
Have you experienced any cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath or other respiratory problem) [Temperature that defines a fever by CDC states 38C or 100.4F]
*
Yes
No
Is the athlete listed above under 18 years of age.
*
Yes
No
If athlete is under 18 years of ago a legal guardian will need to sign this form.
Legal Guardian Name
First
Last
By Signing below I confirm the above information is correct
*