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COVID-19

questionnaire

Wrestler First Name

Wrestler Last Name

Have you experienced any of the following symptoms within the last 14 days? *

Cough

Fever

Loss of taste or smell

Aches and pains, sore throat, headache, excessive tiredness

None of the above

Have you travelled internationally within the last 14 days? *

No

Yes

Have you travelled outside of New England within the last 14 days? *

No

Yes

Have you come into contact with any suspected, probable, or confirmed cases of COVID-19 within the last 14 days? *

No

Yes

If you answered yes to any question, please elaborate:

Initials

Today's Date

COVID-19 WAIVER

I declare that the info I’ve provided is accurate & that I've reviewed the attached waiver in its entirety.

Thanks for submitting!

Hours of operation

MONDAY: 6:00-9:00PM

TUESDAY: 6:00-9:00PM

WEDNESDAY: CLOSED

THURSDAY: 6:00-9:00PM

SUNDAY: 8:00-9:00AM

© 2020 by AWC.

contact us

11 LANCE LANE UNIT 12

GOFFSTOWN, NH 03045

INFO@AGOGEWRESTLINGCLUB.COM

603.935.7312

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