Covid Screening Form (Midland Penetang Baseball)

Print Covid Screening Form
This form must be completed for all games, practices and training sessions. Please list names of all participants and spectators in your group.
Do you have any of the following new or worsening symptoms?
Have you, in the past 14 days:
Participant information
  1. RadDatePicker
    RadDatePicker
    Open the calendar popup.
  4. RadDatePicker
    RadDatePicker
    Open the time view popup.
  5. First Name, Last Name
  7. First Name, Last Name
  9. First Name, Second name
  11. First Name, Second name
Contact Information
  1. Example: [email protected]
  2. Example: ###-###-####
Signature
Human Validation
Printed from midlandbaseball.ca on Thursday, June 24, 2021 at 11:21 PM