PRE-WORKOUT ENTRY COVID-19

PRE-WORKOUT ENTRY COVID-19 SCREENING QUESTIONNAIRE
Full Name *

First Name Last Name
Date

Month Day Year
Date
Temperature:
Are you experiencing any of the following symptoms? Check all that apply.
Fever Fatigue Cough Sneezing Muscle Aches and Pains Sore Throat Diarrhea Headaches Shortness of Breath or Difficulty Breathing New Loss of Smell and/or Taste Chills None of the Above/Healthy as a Horse!
Have you recently been in close contact with anyone who has exhibited any symptoms of COVID-19?

Yes No
Have you recently been in contact with anyone who has tested positive for COVID-19?

Yes No
Have you recently traveled to an area outside of Maryland that is considered a hot spot for COVID-19?

Yes No
If you answered "Yes" to any of the above questions or are experiencing any symptoms, we strongly recommend that you participate in our virtual options.
Signature of Member/Parent/ Guardian:

Clear
Should be Empty:

PRE-WORKOUT ENTRY COVID-19 SCREENING QUESTIONNAIRE