Player Check-In / COVID-19 Screening Questionnaire

Date: 21/01/2021

Date*

Age Group*

U5/U6 (born 2016/2015)
U7/U8 (born 2014/2013)
U9/U10 (born 2012/2011)
U11/U12 (born 2010/2009)

Player's Name U5/U6*

Player's Name U7/U8*

Player's Name U9/U10*

Player's Name U11/U12*

Parent / Guardian Email*

Symptoms of Cold, Flu, or COVID-19*

Is the player experiencing cold, flu or COVID-19-like symptoms, even mild ones (e.g. shortness of breath, cough, sore throat, chills, fever, muscle aches, loss of sense of smell or taste)?

Yes
No

Contact with Individuals Showing COVID-19 Symptoms*

Has the player been in close contact with a person showing symptoms or who has tested positive for COVID-19?

Yes
No

Travel Outside Canada*

Has anyone in the player's household travelled outside of Canada in the last 14 days?

Yes
No

By submitting this form and participating in AYSC activities today you have indicated that you have read and agree to all AYSC and BC Soccer policies and guidelines outlined at https://www.aldergrovesoccer.com/policies/.

Player Check-In / COVID-19 Screening Questionnaire

Safety Policies & Procedures

Important: Please Only Submit on the Day of Training