Springfield/South County Youth Club
Rugby - Daily Health Check-In
Show Progress
Check-In
Review
Confirmation
Check-In
Child or Adult Participant:
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Make Selection
Adult
Child
Participant First Name/Nombre del Participante:
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Participant Last Name/Apellido del Participante:
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Parent/Legal Guardian First Name:
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Parent/Legal Guardian Last Name:
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No Fever Confirmation:
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I confirm that I have checked my child's temperature today and that he/she does not have a fever (temperature higher than 100.4 F).
No Fever Confirmation:
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I confirm that I have checked my temperature today and that I do not have a fever (temperature higher than 100.4 F).
COVID-19 Symptoms/Síntomas de COVID-19
Shortness of breath/Dificultad para respirar
Cough/Tos
Sore Throat/Dolor de garganta
Congestion/Congestión
Nausea & vomiting/Náuseas y vómitos
Headache/Dolor de cabeza
Muscle/Joint pain/Dolor muscular / articular
Diarrhea/Diarrea
Chills/Resfriado
Loss of taste & smell/Pérdida de sabor y olor
No COVID-19 Symptoms Confirmation:
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I understand the listed symptoms above, and that no one in my household, including my child participating today, has a fever or exhibits any signs/symptoms listed above.
No COVID-19 Symptoms Confirmation:
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I understand the listed symptoms above, and that no one in my household, including myself, has a fever or exhibits any signs/symptoms listed above.
No Close Contact Confirmation:
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I confirm that to the best of my knowledge my child participating today has not been in close contact with a sick individual or anyone with a confirmed case of COVID-19 in the last 14 days.
No Close Contact Confirmation:
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I confirm that to the best of my knowledge I have not been in close contact with a sick individual or anyone with a confirmed case of COVID-19 in the last 14 days.
Electronic Signature (Entering your name constitutes your electronic signature and by signing you agree to the SYC "Return to Play" guidelines.):
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Send Confirmation Email to/Enviar correo electrónico de confirmación a:
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