COVID-HealthCheck

    Cough
    Within the last 14-days, have you (or immediate family members) experienced a new cough that you cannot attribute to another health condition?

    Shortness Of Breath
    Within the last 14-days, have you (or immediate family members) experienced new shortness of breath that you cannot attribute to another health condition?

    Soar Throat
    Within the last 14-days, have you (or immediate family members) experienced a new sore throat that you cannot attribute to another health condition?

    Muscle Aches
    Within the last 14-days, have you (or immediate family members) experienced new muscle aches that you cannot attribute to another health condition or a specific activity such as physical exercise?

    Fever
    Within the last 14-days, have you (or immediate family members) had a temperature at or above 100.4° or the sense of having a fever?

    Overall
    Within the last 14-days, have you experienced any chills, Nausea, Congestion, Runny Nose, Diarrhea, or Headaches ?

    PPE
    Within the last 14 days, have you (or immediate family members) had close contact, without the use of appropriate PPE, with someone who is currently sick with suspected or confirmed COVID-19?* (Note: Close contact is defined as within 6 feet for more than 10 consecutive minutes)

    Travel
    Anyone traveling from a known hotspot within the last 14 days will self-quarantine before returning to training or games.

    Within the last 14 days, have you (or immediate family members) traveled to or returning to NJ from any of the states with increases rates of COVID as outlined in the travel advisory link below.

    https://covid19.nj.gov/faqs/nj-information/travel-information/which-states-are-on-the-travel-advisory-list-are-there-travel-restrictions-to-or-from-new-jersey


    PARENT/GUARDIAN SCREENING ACKNOWLEDGMENT AND CONFIRMATION

    If the individual answers YES to any of the questions they will not be allowed to participate.

    This is to certify that I, as parent/guardian with legal responsibility for this participant, do attest to the answers given in this questionnaire to be factual and accurate.

    Please submit form