Wildkit Aquatics

New fever, chills, muscle or body aches

Yes No

New cough, sore throat or runny nose

Yes No

New shortness of breath or difficulty breathing

Yes No

New fatigue or headache

Yes No

New loss of taste or smell

Yes No

New nausea, vomitting or diarrhea

Yes No

Have you been diagnosed with COVID-19 in the last 14 days?

Yes No

Do you have close contact with someone who has been quarantined or confirmed with COVID-19 in the last 14 days?

Yes No

Have you travelled outside of Illinois in the past 14 days, to any of the following places: Alabama, Arkansas, Georgia, Idaho, Iowa, Kansas, Minnesota, Mississippi, Missouri, Montana, Nebraska, North Dakota, Oklahoma, Puerto Rico, South Carolina, South Dakota, Tennessee, Utah, and Wisconsin

Yes No

Is your temperature today above 100.4 degrees Fahrenheit?

Yes No

COVID Self-Certification Screening

Swimmer Name

Do you have any of the following symptoms: