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MYS Illness Report 2022-2023
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* Indicates required question
Player Name (First and Last)
*
Your answer
Team Name (i.e. 2004 Girls Green)
*
Your answer
Person Completing the Form
*
Your answer
Email of Person Completing Form
*
Your answer
Player or Parent Email Address (if different than above)
Your answer
Date of onset of Illness
*
MM
/
DD
/
YYYY
Who is ill?
*
Player
Parent
Sibling
Other member of household
Main symptoms experienced
*
Your answer
Has ill person been tested for COVID-19 or been exposed to anyone who has tested positive for COVID-19? (click on all that are applicable)
*
Yes, they have been tested and are awaiting results
Yes, they have been exposed to someone who tested positive
Yes, they have tested positive
No, they have not been tested
No, they have not knowingly been exposed to anyone who has tested positive
Required
Has a player in this household been to a practice, scrimmage or game in the last 10 days?
*
Yes
No
What is the date of the most recent practice, scrimmage or game attended in last 10 days?
*
MM
/
DD
/
YYYY
Has the coach been notified of illness?
*
Your answer
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