JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
The Super 6s League 2 COVID-19 Symptom Checker
This form must be submitted prior to the Super 6s event day. One form is required for each player or referee/volunteer. This form must be filled out no more than 24 hours before each Super 6s game day.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name
*
Your answer
Surname (Family Name)
*
Your answer
Email
*
Your answer
Mobile Phone Number
*
Your answer
Gender
*
Male
Female
Required
Date of Birth
MM
/
DD
/
YYYY
Are you a player or volunteer?
*
Player
Referee
Volunteer/Staff
Required
Team
BroTown Patu - Men
Exiles Vets - Men
Falcons - Men
Find Fit People U20s - Men
Find Fit People Mens - Men
Untouchabulls - Men
Warriors Mens - Men
Wolves - Men
BroTown Kahu - Ladies
ExiLadies - Ladies
Meteorites - Ladies
UntouchaBelles - Ladies
BroTown Whai - Mixed
Everytime We Touch - Mixed
Must Tag Sallies - Mixed
Untouchables A - Mixed
Untouchables B - Mixed
Warriors Tribe - Mixed
Are you currently diagnosed with or believe you may have COVID-19?
*
Yes
No
Have you had any of the following symptoms of COVID-19 in the past 7 days?
High temperature (fever)
*
Yes
No
A new continuous cough
*
Yes
No
New unexplained shortness of breath
*
Yes
No
Loss of taste or smell
*
Yes
No
Have you been in contact with a COVID-19 confirmed or suspected case in the previous 7 days?
*
Yes
No
If you have answered YES to any of these questions you should stay at home.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Feral.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report