Swim Dogs Daily Health Screening
This daily survey is for parents/guardians with swimmers under the age of 18 and swimmers/coaches over the age of 18.
To be completed at least one hour before practice and no more than 12 hours before your practice start time. This survey must be completed on time for each practice, or you will not be allowed on the pool deck.
Name of Swimmer or Coach Entering JCC
For Practice On This Date
1. Have you or any of your family members experienced any of the following symptoms in the past 72 hours? Chills, Repeated Shaking with Chills, Shortness of Breath or Difficulty Breathing, Fatigue, Muscle or Body Aches, Headache, New Loss of Taste/Smell, Sore Throat, Congestion or Runny Nose, Nausea or Vomiting, Diarrhea
2. Have you or your family members had any signs or symptoms of a fever in the past 72 hours, such as chills, sweats, felt "feverish," or had a temperature that is elevated for you (or 100.4F or greater)?
3. Have you traveled internationally or been on a cruise in the last 14 days? Or, have you had any close contact in the last 14 days with someone with a diagnosis or presumptive positive of COVID-19?
With your signature you are agreeing that all answers above are truthful
Signature of Parent or Swimmer (18 & Over)
Should be Empty: