Orangeville Northmen Lacrosse
Daily Health Check In
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Pre- Screening questions
Review
Confirmation
Pre- Screening questions
Please Fill out questionnaire prior to Game/Practice or event
First Name of Athlete :
*
Last Name of Athlete:
Email Address:
*
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Are you feeling well today?:
*
YES
NO
Are you feeling well today :
*
Yes
No
1. Do you have a cold or the flu or are displaying and COVID symptoms? 2. Has a doctor or health care professional or health unit told you that you should currently be isolating?:
*
YES
NO
What team are you affiliated with :
*
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Jr A Northmen
Jr B Northmen
Jr C Northmen
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Senior Girls
U19 Girls
U15 Girls
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Northmen Girls
U17 Boys Field
U15 Boys Field
U13 Boys Field
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U9 Boys Field
U7 Boys Field
Is there anyone else who is attending this event with athlete - list all people :
*
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YES
NO
Name of Parent joining athlete :
*
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Parent/Guardian Cell Phone:
*
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