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ASC Winter 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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* Indicates required question
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
Choose
2002/2003/2004/2005
2006
2007/2008
2009/2010
2011/2012
2013/2014
2015/2016
2017/2018
OTHER - STAFF/VOLUNTEER
Which Day of the Week are you attending?
*
Que dia participas?
Saturday
Sunday
Monday - Player Development Program
Thursday - Player Development Program
MULTIPLE - STAFF/VOLUNTEER
Required
What is your team name? / Nombre de equipo
*
These are listed out from oldest teams to youngest teams (High School Division --> U7 and U8 Division)
Choose
I'm doing the Winter Futsal Player Development Program
Team Saints 1
Team Saints 2
Team AHS 1
Team Jarvis
Team Fuller
Team Fernandes
Team AHS
Team Castillo
Team DeMarinis
Team Lasell
Team Edwards
Team Stemmler
Team Streit
Team Goulet
Team Kirkpatrick
Team O'Leary U14
Team Bieler
Team Mitchell
Team Hazen
Team Waitt
Team McConnon
Team McConnon 2
Team Ogle
Team Wallace
Team Buckler
Team Name 04
Team Mendez 1
Team Mendez 2
Team Phelan
Team Cola
Team O'Meara U10
Team Gallagher
Team O'Leary
Team McLellan
Team Brown
Team Manofsky
Team Capdepon GU10
Team Cabrera
Team Streit
Team Gargagliano
Team Poole
Team Capdepon
Team O'Meara
Team Cardillo/Donnelly
Team Lewis
Team Rose
Team Eschbach
Team White
I Don't Know My Team Name...
STAFF / VOLUNTEERS
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.
Required
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