Phenom Hoops Initial Screening Questions for Athletes and Coaches to Participate in Athletic Activity During COVID-19
Phenom believes it is essential to the physical, emotional, and mental well-being of our youth to return to athletic activity as soon as deemed safe. However, the health and safety of these student-athletes is vital. Therefore, we are requiring that all participants wishing to be involved in Phenom events complete this form before being allowed to participate in ANY organized activity.Answering these questions truthfully will allow all participants to receive the needed evaluation to safely return to participating in Phenom events, while helping prevent other team members and coaches from being put at risk for contracting the COVID-19 virus or causing the quarantine of some individuals or possibly an entire team.
Name:
*
First Name
Last Name
Email:
*
example@example.com
Select Team
Select the team that you are playing with at this event (Drop Down and Select)
10U
Please Select
11U
Please Select
12U
Please Select
CLT1
BWSL Neptunes 2027
13U
Please Select
Next Level SC 13u
Team Charlotte 13u
14U
Please Select
Next Level SC 14u
No Hype
Raleigh Raiders
Team Loaded 757 2025
15U
Please Select
CC Elite 2024 Cook
East Carolina Elite 2024
Eastern Carolina Phenomz 15u
Elite 1
Flight 9
No Hype 15u
Team AKT
Team Assault
Team HOPE 2024 Laney
Team Loaded 757
Team Loaded 804 15u Baker
Team Loaded NC (BCT)
Team Premier
Wave Basketball Club - Baronne
Wave Basketball Club - Diaz
16U
Please Select
Carolina Bad Boyz
Fly High Ath.
No Hype 16u
Team AKT 16u
Team HOPE 2023 Laney
Team HOPE 2023 McGee
Team Loaded 757
Team Loaded 804
Team Loaded 757 - Lusk
Team Loaded NC 2023
Team Loaded VA
Team Push 16u
VA Havoc 2023 - Johnson
17U
Please Select
CC Elite 2022
District Basketball Club 17u
Eastern Carolina Phenomz 2022
Loaded 757
NC Wildcats 2022
Next Level SC 17u
Randolph Co. Kings of Flight
Team AKT 17u
Team AKT Black
Team Assault
Team HOPE 2022
Team Loaded 17u
Team Loaded 804 - Love
Team Loaded NC 2022
Team Push 17u - Claiborne
Team Push 17u - Crawly
U-Nique All Stars Academy Prep
Virginia Venom
Hoop State Championship
Please Select
Bull City National
Combine Academy - National
Lake Norman Storm
Liberty Heights
Moravian Prep National
Quality Education
Winston-Salem Christian National
Word of God
First in Flight/ PG Nationals
Please Select
Bull City Durham
CBA- NC
Charlotte Elite Academy
Combine Academy Global
Combine Academy- Regional
Elevation Prep
Franklin Prep National
DME (FL)
Fork Union (VA)
Hargrave (VA)
IMG Post Grad FL)
Link Year Prep (MO)
Middle Georgia Prep
Mt. Zion Prep (MD)
Olympus (NJ)
Scotland Prep (PA)
TSF National (GA)
Believe Prep National
Believe Prep Regional
Bull City PG-CLT
Bull City PG-Durham
CBA- GA
Combine Academy PG- Black
Combine Academy PG- White
Experience Academy Kings
Franklin Prep Post Grad
Rocktop
TLAP
Vision Prep
W-S Christian Post Grad- Black
Westlake Prep
Rocktop International
Since January 1, 2020 have you been told that you have had a positive test for COVID-19, OR have you been told by a Doctor, Physician Assistant or Nurse Practitioner that you had to quarantine (stay home) due to concern that you had COVID-19 symptoms?
*
Yes
No
Today or in the past 2 weeks have you had any of the following symptoms:
A fever (temperature more than 100.4° Fahrenheit or 38° Celsius)?
*
Yes
No
Shaking chills?
*
Yes
No
A new or worsening cough, shortness of breath or difficulty breathing?
*
Yes
No
Racing heart, heart skipping beats or fluttering of the heart?
*
Yes
No
Unusual dizziness, particularly with exercise?
*
Yes
No
Fatigue or difficulty with exercise?
*
Yes
No
A sore throat different than associated with seasonal allergies?
*
Yes
No
New loss of taste or smell?
*
Yes
No
Nausea, vomiting or diarrhea?
*
Yes
No
Do you have anyone in your household who has been diagnosed with COVID-19 in the past 14 days?
*
Yes
No
Have you been in contact with anyone infected with COVID-19 in the past 14 days?
*
Yes
No
Heading
By signing this document, I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.
Signature of athlete:
*
Signature of parent/legal custodian:
*
Date:
*
-
Month
-
Day
Year
Draw the shape below to verify that you are human:
*
Submit
Should be Empty: