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NMSA Closed 2021 Pre-Tournament Covid-19 Screening

I am completing this form as: *

A playerAn official

Player/Official Surname *

Player/Official Name *

Cell Phone number *

Have you as player/official been in contact with anyone that has had COVID-19, in the last month? *

YesNoMaybe

Do you as player/official have sudden onset of any of the following? (e.g. fever, cough, sore that, shortness of breath, loss of smell/ taste?) *

YesNoMaybe

To the best of your knowledge are you as player/official currently free of COVID-19? *

YesNoMaybe

I agree to abide by guidelines regarding Level 3 Covid-19 relations and rules of the National Sporting Federation and Government and any rules and regulations promulgated by Squash SA, the club, tournament host or other reasonable parties. *

YesNo

By selecting YES below, I hereby declare that the information I have provided is accurate and complete, and submitted by or on behalf of the player/coach/official taking part in the above tournament. *

YesNo

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