Health Questionnaire - Maestro Soccer

Player Name *

Today's Date *

Is the athlete displaying any of the following symptoms? Fever, cough, sore throat, shortness of breath, chills, muscle pain, headache, new loss of taste or smell, fatigue, congestion or runny nose, nausea or vomiting , or diarrhea. *

YES
NO

In the last 14 days has the athlete or any member of their household tested positive for Covid - 19? *

YES
NO

In the last 14 days has the athlete been in contact or in close proximity with anyone who has tested positive for Covid- 19? *

YES
NO

If you answered YES to any of the above questions please contact your program Coach or Coordinator before attending the program!