One City Schools: Soccer Sunday Health Screening: To be completed 2 hours before (by 12:00 Noon each Sunday -- or, If Not, Please Stay Home.)

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One City Schools, your Health and Safety are vital to keep everyone safe during Soccer Sunday Fun training.

One City Soccer program has no control over what player(s) or Coach members do outside of the training, all are strongly encouraged to minimize contacts and follow CDC guidelines related to social distancing.

We ask that every player(s) considers the safety of our other players during Sunday training time.

We STRONGLY encourage parents to follow CDC guidelines related to social distancing.

All player would be REQUIRED to wear FACE MASKS during play.

We ask that everyone considers the safety of our entire school family during soccer Sunday. If You are SICK, We ask that Parent(s) and player(s) STAY HOME.

This questionnaire **MUST** be completed each Soccer Sunday.

Thank you in advance for your cooperation. (ONE ENTRY PER CHILD)

Any questions/concerns, please contact Marilyn Ruffin, VP Family of Community Initiatives @mruffin@onecityschools.org or call/text @484.531.4372

Email *

SOCCER SUNDAY WITH COACH HENRY!!!

Child's first and last name: *

Age of your child *

5 years old

6 years old

7 years old

8 years old

9 years old

10 years old

11 years old

12 years old

Child's Health Screening - (ONE ENTRY, PER CHILD) Is your child experiencing any of these symptoms, Please select from the list below *

Fever (temperature of 100.4 degrees or higher) within the past 72 hours.

Sore throat

New uncontrolled cough that causes difficulty breathing (For students with chronic allergic/asthmatic cough, a change in their cough from baseline)

Diarrhea

Vomiting

Abdominal pain

New onset of severe headache, especially with a fever

None

Required

Please check off all that apply: *

This child has not taken any fever reducing medications like acetaminophen or ibuprofen in the past 24 hours.

This child is free of symptoms of other communicable illness, and is healthy enough to engage in daily activities including outdoor play.

I have limited the number of people I come into contact with and am abiding by "SAFER at HOME" to prevent the spread of COVID-19

I am aware that our community is reporting a large number of COVID-19 cases currently, and of the importance of consistently following preventive measures.

I am aware that our community is currently experiencing a high level of community transmission (people testing positive but not knowing where they got the illness), and that this is another reason to be consistent in following preventive measures.

Required

Because children can be carriers of the virus -- but show no symptoms -- have YOUR FAMILY been taking precautions such as wearing masks &/or practicing safe distancing? *

Yes

Have had close contact (within 6 feet of an infected person for at least 15 minutes) with a person with confirmed COVID-19? Or under quarantine for possible exposure to COVID-19? *

Yes

If your child becomes SICK throughout Soccer Sunday, who is the best contact person (NAME and CELL NUMBER) to call?: (must be available to pick up your child). *

Any comments/questions/concerns

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