Covid-19 Questionnaire - Infinite Athletics

(if submitting on your phone, you may need to turn horizontally to view entire answer!)

1. Has your child, or someone in your household experienced any of the following symptoms in the past 14 days: fever (100 F or more), cough, shortness of breath, sore throat, congestion or runny nose? *
2. Has your child, or someone in your household experienced any of the following symptoms in the past 14 days: body or muscle ache, extreme fatigue, nausea, diarrhea or vomiting, new loss of taste or smell? *
3. Has your child, or someone in your household been diagnosed or tested positive for COVID-19 in the past 14 days? *
4. Has your child, or someone in your household knowingly been in close contact with or cared for someone diagnosed or tested positive with COVID-19 within the last 14 days? *
5. In the past 14 days, has your child been in close contact with anyone who has traveled to any areas designated by the CDC or to a US State with significant community spread of COVID-19 and listed under a travel advisory by NY State? *
6. If you answered YES to any of these questions, has your child since undergone a Covid-19 PCR test and tested negative? (only reply if you've answered YES)
Parent/Guardian's name *
First
Last
Child's Name *
First
Last

To be completed at least 30 minutes prior to IA activities