COVID-19 NYS PICKUP Screening
Week of November 30th

This form needs to be completed before your child can participate at NYS Pickup.

I agree that I will adhere to the following rules:

Any player who is sick, has a persistent cough, is running a temperature or is displaying any symptoms suggesting that the individual may be ill, (from any contagious malady, including cold, flu, or suspected corona virus) will be prohibited from attending NYS pickup.

It is understood that prior to participation that:

I will take my child’s temperature prior to them attending all sessions. If my child has a fever they will not attend the session.
The player has had no close contact with a sick individual or anyone with a confirmed case of COVID-19.
The player has not had a documented case of COVID-19.  If they did have a documented case, they have since received confirmation that the virus is no longer present in their body through a negative test result.  
The player is not currently demonstrating or suffering from any ill symptoms including the following:

Fever or chills, Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
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Email *
Player Name *
Player Grade *
Parent/Guardian Name *
Do you agree with the Waiver stated above? *
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