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CSC COVID 19 Health Screening
* Required (to be completed before each practice/game/tryout)
If any of the below questions are "YES" please do not send your child to the field.
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* Indicates required question
Email address
*
Your answer
Player's First Name
*
Your answer
Player's Last Name
*
Your answer
Have you had any signs or symptoms of a fever in the past 24 hours such as chills, sweats, felt "feverish" or had a temperature that is elevated for you/100.0F or greater? *
*
1 point
Yes
No
Do you have any of the following symptoms? Cough, Shortness of Breath, Chest Tightness, Sore Throat, Nasal Congestion/Runny Nose, Myalgia (Body Aches), Loss of Taste and/or Smell, Diarrhea, Nausea, Vomiting, Fever/Chills/Sweats *
*
1 point
Yes
No
Have you traveled internationally or outside of state in the last 14 days? Or, have you had any close contact in the last 14 days with someone with a diagnosis of COVID-19? *
*
1 point
Yes
No
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