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The Super 6s COVID-19 Symptom Checker
This form must be submitted prior to the Super 6s event day. One form is required for each player or referree/volunteer. This form must be filled out no more than 24 hours before each Super 6s game day.
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* Indicates required question
First Name
*
Your answer
Surname (Family Name)
*
Your answer
Email
*
Your answer
Mobile Phone Number
*
Your answer
Gender
*
Female
Male
Required
Date of Birth
MM
/
DD
/
YYYY
Are you a player or referee?
*
Check any that apply
Player
Referee
Volunteer/Staff
Required
Team
Check all that apply.
BroTown Kahu - Ladies
Untouchabelles A - Ladies
Untouchabelles B - Ladies
Meteorites - Ladies
BroTown Patu - Men
Wolves - Men
Warriors Mens - Men
Find Fit People U20s - Men
Find Fit People Mens - Men
Falcons - Men
UntouchaBulls A - Men
Exiles Vets - Men
BroTown Whai - Mixed
Warriors Tribe - Mixed
Must Tag Sallies - Mixed
Untouchables A - Mixed
Untouchables B - Mixed
Everytime We Touch - Mixed
Skills Training
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.
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