Foothills Soccer Club- Staff, Coach & Player COVID-19 Pre-Screening Foundation Phase GU9-U12

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This form is required to be completed by all members prior to participating. Form must be filled out on the day of training.

Email *

First and Last Name *

Team Name *

Your phone number *

FORMAT: (XXX)-XXX-XXXX

Select the Training Location you are at: *

Lake Placid Fields

Deer Ridge Fields

Robert Warren Fields

Don Bosco Field

EP Scarlett Fields

Foothills Fieldhouse

Foothills Skills Center

Calgary Soccer Center

Calgary West Soccer Center

Deer Run Elementary School Field

Other:

Enter your Practice Start Time *

Time

Who drove you to soccer today? *

Parent(s)

Drove myself

Other:

Who is picking you up from soccer today? *

Parent(s)

Drove Myself

Other:

Do you have any of the below symptoms? *

Check all that apply.

Fever (Greater than 38.0c)

Cough

Shortness of Breath

Sore Throat

Runny Nose

None

Required

Has your child traveled outside of Canada in the last 14 days? *

Yes

Have you, or anyone in your household traveled outside of Canada in the last 14 days? *

Yes

Have you, or anyone in your household been in contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? *

Yes

Are you currently being investigated as a suspect case of COVID-19 *

Yes

Have you tested positive for COVID-19 within the last 10 days? *

Yes

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