Daily Health Questionnaire

Glendora National Little League is committed to keeping all players, spectators, and volunteers safe. To prevent the spread of COVID-19 and reduce the potential risk of exposure, and in line with LA County Health Protocols, GNLL is requiring all parents to complete this Daily Health Questionnaire for their players prior to arrival at every practice or game.

Event Date * +

Player First Name *

Player Last Name *

Parent Name *

Contact Phone Number *

Team: *

Has your child or anyone in your household had a fever (100.4º F) or higher in the last 48 hours? *

Yes

No

Is your child or anyone in your household experiencing any of the following COVID-19 Related Symptoms or combination of symptoms, unrelated to any pre-existing conditions? *

Has your child or anyone in your household been in contact with anyone while they had COVID-19 or Symptoms of COVID-19 in the past 14 days? *

Yes

No

Are you or anyone in your household currently waiting for COVID-19 test results? *

Yes

No

Have you or anyone in your household tested positive for COVID-19 in the last 14 days? *

Yes

No

By signing below, I certify that my answers to the above are true and accurate as of the date and time listed. I understand that if it is discovered I signed this form while knowingly providing false information, I will face consequences including suspension, investigation and possible removal from the GNLL Spring 2021 season without refund. I further understand if I have answered YES to any of the above questions, my child will not be admitted to practice today, and agree not to send them to practice until such time as I can answer NO to all applicable questions *

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