SAINTS FA

ARE YOU EXPERIENCING ANY OF THE FOLLOWING SYMPTOMS? 1. EXTREME DIFFICULTY BREATHING 2. SEVERE CHEST PAIN OR PRESSURE 3. SEVERE WEAKNESS

ANSWER TO QUESTION #1

YES, I'M EXPERIENCING ONE OR MORE OF THESE SYMPTOMS
NO, I'M NOT EXPERIENCING ANY OF THESE SYMPTOMS

HAVE YOU BEEN IN CLOSE CONTACT WITH SOMEONE DIAGNOSED WITH COVID-19 IN THE PAST 3 DAYS?

YES
NO

HAVE YOU BEEN IN CLOSE CONTACT WITH SOMEONE SICK WITH A FEVER IN THE PAST 3 DAYS?

YES
NO

IS ANYONE IN YOUR HOUSE FEELING SICK TODAY?

YES
NO

HAVE YOU EXPERIENCED ANY OF THE FOLLOWING IN THE LAST 3 DAYS? SELECT ALL THAT APPLY.

CHILLS OR SWEATING
ACHING (THROUGHOUT THE BODY)
COUGH
SORE THROAT
CAN'T SMELL
VOMITING OR DIARRHEA
HEADACHE
CAN'T TASTE FOOD
FATIGUE
FEVER (100.4 OR ABOVE)
CONGESTION OR RUNNY NOSE
I'M NOT EXPERIENCING ANY SYMPTOMS RIGHT NOW.

DID YOU MISS YOUR LAST MEAL?

YES
NO

DO YOU FEEL WELL ENOUGH TO GO TO SOCCER PRACTICE TODAY?

YES
NO

PLAYER SUBMITTING THIS FORM.

#1 LUIS RUELAS
#3 MARCO ARROYO
#4 HUMBERTO MORALES
#5 GIOVANNI MARTINEZ
#6 DANIEL MONTERO
#7 KEVIN PACHECO
#8 WILLIAM OCHOA
#9 BRYAN AVILES
#10 DIEGO RIVAS
#11 GABRIEL HERNANDEZ
#12 ADRIAN CARDONA
#14 ERICK AVILA
#15 SANTIAGO GONZALEZ
#16 EDUARDO TORRES
#18 OSCAR AVILES
#21 ANGEL SOTO
#23 ULISSES FABELA
#24 JAVIER MORALES
#30 JOSUE RAMIREZ
#64 ORLANDO HERNANDEZ
New Member/Player

User Agreement

By continuing, you agree to our Privacy Policy and Terms of Service. Thank you again for taking the survey today. we look forward to seeing you at practice as always safe and with good health. your survey will be review and you will be notified in the BAND APP if your player is able to practice today. 

Signature and Date