2021 Show Me Girls Qualifier COVID-19 Symptom Screening Form

Please complete this screening form for these symptoms before you enter the venue. Please contact Bernie MacLean (bernie.maclean@usav.org) if you have any questions.

Name *

Cell Phone Number: *

Fever? *

Yes

No

Cough *

Yes

No

Shortness of breath *

Yes

No

Runny Nose? *

Yes

No

Head or Body Aches? *

Yes

No

Sore Throat? *

Yes

No

Nausea, Vomiting or Diarrhea? *

Yes

No

Loss of taste or smell? *

Yes

No

If you have indicated yes to one or more of the the symptoms, then please do not enter the event facilities. Submit the form and a member of our events staff will be in touch at their earliest opportunity.