Basketball Tournament Player Health Screening
Player Name
Date of Birth
Team Name
Contact Number
Emergency Contact
Medical Conditions
Allergies
Current Medications
Date of Last Physical Exam
Has the player experienced any of the following in the last two weeks?
Fever
Cough
Shortness of Breath
Sore Throat
Fatigue
Other
Has the player been diagnosed with COVID-19 in the past 3 months?
Yes
No
Physician Clearance (if required)
Additional Notes