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COVID-19 SELF ASSESSMENT
The COVID-19 Self Assessment is required to be completed prior to each practice or game
*
Indicates required field
Players Name
*
First
Last
Email
*
Have you tested positive for COVID-19 in the last 14 days?
*
No
Yes
Have you traveled outside Conecticut, Maine, Massachusetts, New Hampshire, Rhode Island or Vermont in the last 14 days?
*
No
Yes
Have you been exposed to someone who tested positive for COVID-19 in the last 14 days?
*
No
Yes
Do you have any new, unexplained or worsening of the following symptoms? Check all that apply
*
Temperature over 100 F
Cough
Shortness of Breath
Diarrhea
Nausea of Vomiting
Loss of Taste or Smell
Sore Throat
Fatigue
Body Aches
Headache
Runny Nose or Congestion
Chills
None of the above
By checking this box, you are stating that all of your answers are true to the best of your knowledge and did not intentionally make any false statements or answers
*
YES, all of my answers are true
Todays Date
*
Submit
Home
Our Sports
Basketball
>
Tournaments
Soccer
>
Recreational Soccer
Competitive Soccer
Indoor Soccer
3v3 Nationals
Mini Revs
Futsal
Tournaments
CAMPS
>
Camps & Training
Camps & Training
About Revs
Contact
Leadership Team
Uniforms & Apparel
Revs Logo
Using Our App
Sign Up
News
Health Check