COVID-19 Exposure Report Form

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We want to keep all players, parents, staff, and officials safe.

If you or a close relative is diagnosed with Covid-19 or if you are exposed to someone who has please submit this form to notify TVSC.

You are not required to share this information but doing so will help us to minimize the potential spread and/or notify those who might have been exposed.

The information here will be kept strictly confidential and we will only use for the purposes of:
-notify those who might have been exposed (without sharing specific information)
-cancel or re-schedule activities
-additional cleaning and safety procedures

Nature of Report *

Confirmed COVID-19 Case

Potential COVID-19 Case

Notification of Self Quarantine

Notification of Medical Quarantine

Other:

Required

First Name *

First Letter of Last Name *

Are you... *

Player

Family Member

Spectator

Coach

Referee

Other:

Coaches' names (if known)

Program/Team Name/Age Group *

Date of last attended training/game/activity *

YYYY

Date diagnosed or exposed to Covid-19 *

YYYY

Submit

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