Home
About
COVID-19 Information
Team
Mission and Vision
Programs
Day at the Beach
Wounded Warrior
Adaptive Surfing Clinic
Adaptive Swim Clinic
Canoe Day
Hawaii Adaptive Surf Team
Media
Sponsors
Get Involved
Donate
Volunteer
Participate
Forms
Participant Form and Waiver
Volunteer Form and Waiver
Testimonials
COVID-19 Volunteer Opportunities
Other Volunteer Opportunities
Events
Events Calendar
Ocean of Possibilities
Online Adaptive Surfing Contest Pictures
News
Contact
Donate
Shop
Home
About
COVID-19 Information
Team
Mission and Vision
Programs
Day at the Beach
Wounded Warrior
Adaptive Surfing Clinic
Adaptive Swim Clinic
Canoe Day
Hawaii Adaptive Surf Team
Media
Sponsors
Get Involved
Donate
Volunteer
Participate
Forms
Participant Form and Waiver
Volunteer Form and Waiver
Testimonials
COVID-19 Volunteer Opportunities
Other Volunteer Opportunities
Events
Events Calendar
Ocean of Possibilities
Online Adaptive Surfing Contest Pictures
News
Contact
Donate
Shop
COVID-19 Screening Questions
Please answer honestly and to the best of your ability.
Thank you.
COVID-19 Screening Questions
Full Name
*
Communication Preferences
*
Email
Phone Call
Text Message
Postal Mail
Smoke Signal, Carrier Pigeon, Fireworks, etc.
Smoke Signal, Carrier Pigeon, Fireworks, etc.
Have
- YOU
,
- ANYONE IN YOUR HOUSEHOLD
, or
- ANYONE WHO YOU HAVE BEEN IN CLOSE CONTACT WITH
(Close Contact = unable to maintain 6 feet of separation and were not wearing a face mask):
been caring for an individual who is quarantined due to exposure to COVID19 or traveling within the last 21 days?
*
Yes
No
If yes, please explain the circumstances:
been tested for COVID-19 (is waiting for their result(s), or tested positive for COVID-19 within the last 30 days?
*
Yes
No
If yes, please explain the circumstances:
had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches, shortness of breath, loss of smell, loss of taste, fever at/or greater than 100 degrees Fahrenheit?
*
Yes
No
If yes, please explain the circumstances:
visited/worked or received treatment in a hospital, nursing home, rehabilitation center, long-term care, or other health care facility in the past 21 days?
*
Yes
No
If yes, please explain the circumstances:
traveled to a neighbor island or outside of Hawaii within the last 14 days?
*
Yes
No
If yes, please explain the circumstances:
If you are human, leave this field blank.
Submit