Player's Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Contact Phone *

(###)

###

####

Has participant been around anyone testing positive for Covid-19 in the last 2 weeks? *

Yes

No

Has participant recently had a cough? *

Yes

No

Has participant had a fever recently? *

Yes

No

Has participant had shortness of breath? *

Yes

No

Checking this box acts as my signature. *

I confirm that the information given in this form is true, complete and accurate.