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Covid Screening – Richmond United
By Fusion FC
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Covid Screening - Richmond United
1. Do you have a fever?
*
No
Yes
2. Do you have any of the following signs or symptoms?
*
New onset of cough
New loss or decrease in sense of taste or smell
Runny nose
Sore throat
Sneezing (not allergy related)
Shortness of breath/difficulty breathing
Chills
Nasal congestion
Headache
Nausea/vomiting or diarrhea
None
3. Have you travelled outside of Canada or have had close contact with anyone who has travelled outside of Canada in the past 14 days?
*
No
Yes
If you have answered "yes" to any question Please Do Not Attend..
Player's Name
*
First
Last
Age Group
*
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
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