COVID SELF-REPORT

Help manage the spread and exposure of COVID 19 within MCF and our community. Simply fill out the form below if you've tested positive for COVID 19 and provide us with the requested information. Your information will remain anonymous and we'll handling letting any necessary members know about potential exposure.

COVID 19 SELF-REPORTING FORM

* Indicates required field

Name *

First

Last

Email *

Phone Number *

COVID 19 Date of Positive Test Result *

Date and time of last class attended *

Date you first experience symptoms (or no symptoms) *

Person(s) in contact with while in the gym. *

Did your coach wear their mask while in close contact with members during your class? *

Yes No

Submit

COVID 19 SELF-REPORTING FORM

MOSSY CREEK FITNESS

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