COVID-19 Daily Health Screening Daily Health ScreeningPlease complete and submit this form before entering Schafer Sports Center.Please enable JavaScript in your browser to complete this form.Participant's Name *FirstLastParent's Name *FirstLastToday's Date *Email *Phone *Have you (Participant) been ill with a fever, chills, cough or body aches in the last 14 days? *YesNoHas anyone in your household had these symptoms in the last 14 days? *YesNoHave you or anyone in your household traveled internationally in the last 14 days? *YesNoHave you (Participant) or anyone in your household traveled to a location in the US where an increase of incidences of COVID-19 has been reported in the last 14 days? *YesNoNOTE: If a visitor has traveled to any state on the travel advisory list as specified on the covid19.nj.gov website, we are asking you to stay away for a period of 14 days. After that time you may fill out the form again and enter our facility.Have you (Participant) been told by a healthcare provider that you should self-quarantine due to potential COVID-19 exposure or you are suspected of having COVID-19? *YesNoWho is filling out this form? *If you are an adult filling out this form for a minor, what is your relation to the child: parent, guardian, grandparent etc. If an adult filling the form out for self, simply place your full name.By checking the box below, you agree that your statements are all true to the best of your knowledge. *I agreeSignature *Clear SignatureI agree that I am 18 years of age and all of the statements are true to the best of my ability.Captcha * = CommentSubmit
