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ASC Tots & Mini Tots Program COVID-19 Self Certification
Use this form before attending EACH training to certify that you are healthy for participation. This should be completed ON THE DAY OF EVENT every time.
Disclaimer: While ASC is implementing safety efforts following all jurisdictional guidelines, the COVID-19 pandemic is ever-changing and mitigation plans may need to be updated. All players/staff are assuming all risks by participating in our Program.
Utilice este formulario antes de asistir a CADA capacitación para certificar que está sano para participar. Esto debe completarse EL DÍA DEL EVENTO cada vez.
Descargo de responsabilidad: si bien ASC está implementando esfuerzos de seguridad siguiendo todas las pautas jurisdiccionales, la pandemia de COVID-19 está en constante cambio y es posible que sea necesario actualizar los planes de mitigación. Todos los jugadores / personal asumen todos los riesgos al participar en nuestro Programa.
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Please enter participant LAST name:
*
Entra tu APELLIDO
Your answer
Please enter participant FIRST name:
*
Entra tu PRIMER NOMBRE
Your answer
What is your gender?
*
Cuál es su género
Male
Female
Prefer Not to Say
What is your birth year?
*
Tu ano de naciomiento
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2017
2018/2019
STAFF
By clicking each box below, I attest to the following:
*
I have had no fever for at least three days without taking medication to reduce fever during that time.
I have had none of the following symptoms in the last seven days: fever or chills, cough (either new, or different than your usual cough), sore throat, shortness of breath, loss of the sense of smell or taste, or any flu-like symptoms
I have not tested positive for Covid-19 within the past 14 days
I have not been in close (less than 6 feet) contact with someone with suspected or confirmed COVID-19 within the past fourteen days.
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