Beach FC COVID-19 Player Self Reporting Form
In accordance with the Americans with Disabilities Act (ADA) and the Health Insurance Portability and Accountability Act (HIPAA), the identity of the individual and all medical information will be kept confidential and will only be shared with local health officials, if required.

Please email health@beachfc.com or use the unique editing url in your form submission confirmation email if there are any changes to the answers provided.

Refer to https://www.beachfc.com/covid-19-update/covid-19-stay-informed for the Beach FC COVID-19 policy.
Sign in to Google to save your progress. Learn more
Self Reporting Player Name *
Vaccination Status

Those considered Fully Vaccinated are "up-to-date" on their COVID vaccinations:
 
• Received the J&J/Janssen vaccine within the last 2 months; OR
• Completed the Moderna vaccine series within the last 6 months; OR
• Completed the Pfizer-BioNTech vaccine series within the last 5 months; OR
• Received the primary series of a COVID-19 vaccine and a booster shot.

Player Vaccination Status (as defined above) *
Team Name *
Coach Name
Date of last team event attended
MM
/
DD
/
YYYY
Email Address *
Do you have a household member(s) also part of Beach FC? *
If so, what team is the household member(s) a part of?
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms