Oakridge Soccer Club | Player Screening

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You are completing this form as part of the Oakridge Soccer Club's COVID-19 Screening Process. This form must be completed for every session a registered player is taking part in as a member of a team that plays under the Oakridge Soccer Club banner.

All submissions will be logged by the Oakridge Soccer Club for the purpose of Contact Tracing as outlined by the Government of Ontario and Ontario Soccer.

Once you have completed the survey, a copy of your responses will be sent to you via email. Please forward this copy to your team Head Coach and/or Manager for tracking.

Thank you.

The Oakridge Soccer Club

Email *

Please provide your child's first and last name (the participant) *

What team does your child play for? (Age group & team name) Ex: U13G Firebirds *

Date of next session your child will be attending? *

YYYY

Has your child (the participant) had close contact (within the last 5 days) with a person who has tested COVID-19 positive? *

Yes

If you replied 'Yes', was the close contact a family member? If so, your child can not attend any soccer sessions and must isolate for 5 days. Please refer to the Government of Ontario Self-Assessment Tool, you will get a recommendation on what to do next: https://covid-19.ontario.ca/self-assessment/ . I understand & agree to this directive. *

I understand & agree to this directive.

Does not apply as my child has not had a close contact.

If you replied 'No' to not having close contact with someone who was COVID-19 positive, as of this moment, does your child have any of the following: *

Headaches

Fever/chills

Cough

Difficulty breathing

Shortness of breath (even when sitting/walking)

Sore throat

Runny or congested nose (not allergies)

Nausea, vomiting, diarrhea, or loss of appetite

Feeling unwell for unknown reason, unusual level of fatigue

Loss of smell or taste

None of the above

Required

I acknowledge that if I answered yes to any of the above questions other than close contact without symptoms, I will not send my child (the participant) to an Oakridge Soccer Club team event (practice, training, scrimmage, game etc) and will notify the team Head Coach and/or team Manager of their absence. *

Yes

Required

Today's Date *

YYYY

Time of Survey Completion *

Time

Version: 4Mar2022

A copy of your responses will be emailed to the address you provided.

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