• Social Ride Pre-Screening Form

    Please complete this form for EACH social ride you plan to attend
  •  -  -
    Pick a Date
  • Please check YES or NO for each question or statement. 

  • 3.  In the last 14 days, have you or anyone you have had close contact with experienced any of the following symptoms?

    • Fever, chills, or shaking
    • Difficulty breathing
    • New or worsening cough
    • Sore throat
    • Headache
    • Muscle pain / aching throughout body
    • Vomiting / diarrhea
    • New loss of taste or smell
  • ATTESTATION:

    My signature below certifies that the answers to the above statements are true and correct.

  • Clear
  • Should be Empty:
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