PSA COVID Intake

Premiere Softball Academy Pre-Lesson COVID Intake

This intake form is required before all in-person lessons. Please fill it out BEFORE you arrive for your lesson.

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* 1. Students Name

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* 2. Within the PAST 14 DAYS, have you been in close physical contact (6 feet or closer for at least 15 minutes) with a person who is known to have laboratory-confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19?

Yes

No

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* 3. Have you EXPERIENCED any of the following symptoms in the past 48 hours:

Fever or Chills

Coughing

Shortness of Breath or Breathing

Fatigue

Muscle or Body Aches

Headache

Loss of Smell or Taste

Sore Throat

Congestion or Runny Nose

Nausea or Vommiting

Diarrhea

New or unexplainable rash

None of the Above

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* 4. Are you CURRENTLY AWAITING the results of a COVID-19 test?

Yes

No

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* 5. Have you ATTENDED or PLAYED in a softball tournament/friendly/clinic/camp/team practice within the past 7 days?

Yes

No

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* 6. Do you AGREE to wear a mask during your entire lesson at PSA?

Yes

No

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* 7. Has anyone in your family been VACCINATED yet?

Yes

No

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* 8. Are you ATTENDING school in person?

Yes

No

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* 9. Where would you like your lesson to be?

Christie's BACKYARD, I understand that I need to provide MOST of my own equipment for my lesson.

The PARKING LOT, across the street from Christie's house, I also understand that I need to provide ALL of my own equipment for my lesson.

ZOOM. I wish to keep my lesson on ZOOM.

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* 10. I HAVE READ through the Google Doc provided by Christie regarding all of the new COVID and lesson adjustments for PSA starting in March 2021.

Yes

No