Health Screening Form - Next Level Sports

Next Level Sports Health Screening Form

To prevent COVID-19 from spreading in our community, we require everyone to complete the health questionnaire below before entering the facilities.

First name

Last name

Email address

Program

Select the program you are particpating in.

In the last 48 hours, has your child/participant had a fever or elevated temperature above 100℉ (37.8℃)?

Yes

No

In the last 48 hours, has your child/participant had ANY of the following new or worsening symptoms: cough, or chills, or shortness of breath, or difficulty breathing, or sore throat, or muscle pain/aches, or headache, or nausea, or vomiting, or diarrhea, or loss of the ability to smell or taste?

Yes

No

Have you or anyone you have come in contact with been diagnosed with COVID-19 in the last 14 days?

Yes

No

Do you give consent to have the screening required by Next Level Sports?

Yes. I give my consent