Foothills Soccer Club- Staff, Coach & Player COVID-19 Pre-Screening Recreation Phase

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This form is required to be completed by all members prior to participating. Form must be filled out on the day of training.

Email *

Player: First and Last Name *

Team Name *

Your phone number

FORMAT: (XXX)-XXX-XXXX

Select the Training Location you are at:

Lake Placid Fields

Deer Ridge Fields

Robert Warren Fields

Don Bosco Field

EP Scarlett Fields

Foothills Skills Center

Foothills Fieldhouse

Calgary Soccer Center

Calgary West Soccer Center

Other:

Clear selection

Enter your Practice Start Time

Time

Who drove you to soccer today? *

Parent(s)

Drove myself

Other:

Who is picking you up from soccer today? *

Parent(s)

Drove Myself

Other:

Has the child traveled outside Canada in the last 14 days?

Yes

Clear selection

Has the child had close contact with a positive case of COVID-19 in the last 14 days? (face to face contact within 2 meters for 15 minutes or longer, or direct physical contact such as hugging)

Yes

Clear selection

Does the child have any new-onset (or worsening) of the following symptoms? *

Check all that apply.

Fever (Greater than 38.0c)

Cough (Continous Cough, more than usual, not related to other known causes)

Shortness of Breath (Unable to breath deeply)

Loss of smell or taste

None

Required

Have you traveled outside of Canada in the last 14 days? *

Yes

Are you currently being investigated as a suspect case of COVID-19 *

Yes

Have you tested positive for COVID-19 within the last 10 days? *

Yes

Submit

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