WYSA Health Card Team Gr2Boys-04 Gold (McNiff)

Date of Practice / Game *

MM

/

DD

/

YYYY

Player's Name *

Please read each of the below statements carefully and select "Read and Agree" for all the true statements for the player and any planned attendees. *

If any of the following questions are not true, the player is NOT ALLOWED to attend practice. These questions must also be applicable to any spectators of games/practices. You are responsible for all of your guests being in alignment with these directions.

Read and Agree

Does not currently have COVID-19.

Has not had any of the following within the past 48 hours: Cough, Shortness of breath, or difficulty breathing, Chills, Muscle Aches, Sore Throat, Loss of Smell or Test (or a Change in Taste), Nausea, Vomiting, Diarrhea, Headache, Fatigue, Fever (over 100.4 degrees Fahrenheit)

Has not been in close contact with anyone who has exhibited symptoms of COVID-19 in the last 48 hours.

Has not been restricted from participating by a healthcare provider or the Board of Health.

If anyone has traveled in the past 10 days to or from any states restricted by the Commonwealth of Massachusetts travel advisory, all of the necessary steps required by the advisory will be completed prior to returning to soccer related activities.

If anyone has recently traveled to a restricted area that is under a level 2, 3 or 4 travel advisory according to the U.S. State Department, all of the necessary steps required by the order will be completed prior to returning to soccer related activities

For any questions that cannot be answered confidently, the parent/guardian has reached out to the COVID Safety Officer for written (email) approval to attend any soccer-related events. covid@westfordyouthsoccer.com

Read and Agree

Does not currently have COVID-19.

Has not had any of the following within the past 48 hours: Cough, Shortness of breath, or difficulty breathing, Chills, Muscle Aches, Sore Throat, Loss of Smell or Test (or a Change in Taste), Nausea, Vomiting, Diarrhea, Headache, Fatigue, Fever (over 100.4 degrees Fahrenheit)

Has not been in close contact with anyone who has exhibited symptoms of COVID-19 in the last 48 hours.

Has not been restricted from participating by a healthcare provider or the Board of Health.

If anyone has traveled in the past 10 days to or from any states restricted by the Commonwealth of Massachusetts travel advisory, all of the necessary steps required by the advisory will be completed prior to returning to soccer related activities.

If anyone has recently traveled to a restricted area that is under a level 2, 3 or 4 travel advisory according to the U.S. State Department, all of the necessary steps required by the order will be completed prior to returning to soccer related activities

For any questions that cannot be answered confidently, the parent/guardian has reached out to the COVID Safety Officer for written (email) approval to attend any soccer-related events. covid@westfordyouthsoccer.com

If your player been in close contact with someone diagnosed with COVID, read the information below carefully, and select "Read and Agree" if the statement is true. If you have NOT emailed the WYSA COVID Safety Officer, the player is NOT ALLOWED at any soccer related activities.

If you have been notified your player has been a Close Contact of someone with COVID-19, you MUST email the WYSA COVID Safety Officer at covid@westfordyouthsoccer.com. The rules align with the school rules (per Department of Education and Secondary Education (DESE) and the CDC). In addition, if they have received a negative test, results must be mailed to covid@westfordyouthsoccer.com along with the note from the school / Board of Health / nurses with the return to school plan/dates. This is per Mass Youth Soccer's direction. All information will be kept confidential. This information does NOT need to be sent to your coach or age director. Only access is to the COVID Safety Officers and President of WYSA.

Read and Agree

You have received written (email) permission for the player to return to soccer activities.

List names and ages of any planned attendees (other than the player) of the practice or game.

2 adults and all siblings allowed at games. You must wear a mask at all times and socially distance your family unit from others. Any planned attendees must also follow the rules of the health card above! If any planned attendees cannot answer that they have read and agree with the previous two questions, they are NOT ALLOWED to attend any WYSA event.

Electronic Signature - Type name of person signing form

I attest that the information I am providing is true and accurate. The undersigned, on behalf of the player identified below, hereby represents, warrants and acknowledges that I have read and understand my responsibilities as a Parent/Guardian according to the Massachusetts Youth Soccer COVID 19 Soccer Protocols prior to participating in any town program, club, or league soccer related activities. This includes, but is not limited to, individual or team practices, clinics, training, games, tournaments, meetings or classes. I understand that any falsification or omission of the information provided above, could result in disqualification from participating in any Massachusetts Youth Soccer Association sanctioned soccer related activity for no less than a year.