Daily Health Screen

First Name

Last Name

Parent First

If player is under 18

Parent Last

Email

Phone

Phone Service Provider

Fever (≥ 100.4°F)

Cough or shortness of breath

Chills

Sore Throat

Muscle aches or rigors

Headache

New loss of taste or smell

Abdominal pain, nausea, vomiting or diarrhea

Have had close contact with someone who is currently sick

Been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19

Traveled or had close contact with anyone who has traveled internationally in the last 14 days

What was your temperature reading before practice?

Math question 15 + 4 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.