Entrant Information
Entrant Address
List Riders and Crew
Have you or any of your team or guests had any of the following symptoms in the last 14 days
Fever above 100.4F Cough Shortness of breath Sore throat New loss of taste or smell None of the Above
Have you or anyone you have had contact with been diagnosed with COVID-19 in the last 14 days
Myself A person I have had contact with A member of my team or guests None of the above
Have you or any of your team or guests been out of the United States in the last 14 days
YesNo
If yes what country?
If yes, Have you self quarantined 14 days prior to the event
Are you or any of your guests or crew the age of 65
If you or any of your team or guests are over the age of 55 do you or any of your team or guests have any of the following pre-existing conditions
Diabetes. Type 1 or 2 Hypertension Cardiovascular Conditions. Coronary Artery Disease, Vascular Disease, Valvular Disease, Congestive Heart Failure Pulminary Coniditions. COPD, Asthma, Emphesema, Pulminary Fibrosis Immune Disorders of Suppression from the treatment of malignancy or autoimmune conditions Any other serious chronic medical conditions that could affect a person ability to fight infection None of the above
If you or any of your team or guests have any of these conditions above, do you or any of your team or guests have a doctors order clearing you to participate?
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