top of page

COVID-19 SELF ASSESSMENT FORM

This form is to be filled out within 2 hours of your scheduled start time and to be signed and handed into FWF Staff prior to getting to your field. You will not be allowed to participate without this completed form or if you are exhibiting any of the below symptoms.

SYMPTOMS INCLUDE:

  • Cough

  • Difficulty Breathing

  • Fever (100.5 F or above)

  • Chills

  • Sore Throat

  • Loss of taste or smell

PLAYER INFO:

PLAYER NAME:

CURRENT TEMPERATURE:

CONTACT NUMBER:

GAME TIME:

arrow&v

DATE:

ATTENDEE INFO:

At this time there is a spectator limit of (5) five per player. This is subject to change as guidelines are becoming more relaxed. Please include spectator self assessment information below.

ATTENDEES:

1

2

3

4

5

CURRENT TEMPERATURE:

Have you had a cough, shortness of breath/difficulty breathing, a fever, chills, muscle pain, sore throat or loss of taste or smell within the last 14 days?

Have you been in contact with anyone that has had a cough, shortness of breath/difficulty breathing, a fever, chills, muscle pain, sore throat, or loss of taste or smell within the last 14 days?

PARENT/GUARDIAN SIGNATURE:

Your form has been successfully submitted!

bottom of page