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Daily Health Check Questionnaire

For the safety of our players and coaches, we require all players and coaching staff to submit a daily health check questionnaire prior to all FLEXX indoor activities. We do this for the safety of players and coaches who participate. We thank you in advance for your support and commitment to this important health and safety process.

Loudoun FLEXX Exec Management


Required Daily Health Check Questions

In the past 24 hours have you or anyone in your house had:

  • A temperature of 100°F or above?

  • New cough?

  • New shortness of breath?

  • New sore throat that cannot be attributed to another health condition?

  • Gastrointestinal symptoms (diarrhea, nausea, vomiting)?

  • New nasal congestion or new runny nose?

  • New loss of smell and or taste?

  • New muscle aches?

  • Any other sign of illness?

  • Contact with someone in the previous 14 days with confirmed diagnosis of COVID-19 or someone who is ill with a respiratory illness?

If you answered Yes to any of these questions you are not permitted to participate. You should not attend or return, until you or your family member is fever and symptom-free, without the use of medication for the fever or symptoms for three days.

If a player or coach test positive the entire team and their families may be subject to quarantine by the Virginia Department of Health.

I being the parent of the player named below, hereby agree that I will hold the Loudoun FLEXX Basketball (“Flexx”) and its officers, directors, and coaches faultless in the event of injury or other harm occurring to the my child at any associated Flexx event, tryout, practice, games, or tournaments or at any such event that Flexx participates in. By signing this “Waiver of Liability” I attest to the organizer, Loudoun Flexx Basketball, that adequate medical insurance is available for my child and that I am solely responsible for any medical expenses if necessary.

By clicking the boxes below you are confirming You and Player named below:*

Health Check*


Player Name*

Parent Name*

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