Oregon Open Cup 2020

Name*

First Last

Email

Birthdate*

Phone*

Address

Street Address City State ZIP Code

Temperature Check*

Do you have a fever (temperature over 100.3F) without having taken any fever reducing medications?*

No
Yes

Have you experienced signs or symptoms of COVID-19 such as fever, cough, sore throat, lost of taste/smell, or shortness of breath within the last 14 days?*

No
Yes

Is anyone in your household experiencing any of the above-listed symptoms?*

No
Yes

Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days?*

No
Yes

Have you had direct contact with someone who has a confirmed case of COVID-19 or is under investigation for possible COVID-19 infection within the last 14 days?*

No
Yes

Have you traveled to an area known to have high numbers of positive cases of COVID-19 within the last 14 days?*

No
Yes

I certify that the information submitted in this application is true and correct to the best of my knowledge. I further understand that any false statements may result in denial or revocation.*

I Agree

Oregon Open Cup Game Screening Questionnaire