EYSC COVID-19 HEALTH CHECK:  Pre-Training Assessment
Please complete this form prior to each training session by 4:30pm for each individual child (player, coach, technical staff, manager).  Please answer all questions as honestly as possible and to the best of your knowledge.  This assessment is part of your eligibility to train.
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Player's / Staff member's Full Name (First Name, Last Name) *
Full name of person completing this form (First Name, Last Name). *
Mobile  Phone Number including area code *
Relation to Player *
Role *
Team / Age Group *
Are you experiencing the following symptoms?
Fever (greater than 38C or 100.4F)? *
Cough? *
Shortness of breath / difficulty breathing? *
Sore throat? *
Runny nose? *
Has anyone in your household experienced any of the above symptoms in the last 14 days? *
Have you, or anyone in your household travelled outside of Canada in the last 14 days? *
Have you, or anyone in your household been in contact in the last 14 days with someone who is being investigated as a suspected case of COVID-19? *
Are you currently being investigated as a suspected case of COVID-19? *
Have you tested positive for COVID-19 within the last 10 days? *
If an individual answers YES to any of the above questions, they are not permitted to participate in any in-person soccer activity for a minimum of 14 days.  Please contact president@etobicokeyouthsoccer.com immediately and visit a health care provider.  For a list of test centres or online assessment visit: https://covid-19.ontario.ca/
I certify that the information submitted in this application is true and correct to the best of my knowledge.  I further understand that any false statements may result in legal and/or disciplinary action.  Please check the box below to confirm. *
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