WC - SCP Covid 19 Questionnaire

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World Class - SCP

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World Class - SCP COVID-19 RELEASE AND WAIVER OF LIABILITY:This question is required. *The undersigned acknowledges the contagious nature of the Coronavirus/COVID-19 and that public health authorities have recommended abiding by certain precautions, including social distancing. The undersigned further acknowledges that WC - SCP has put in place preventative measures to reduce the exposure to and spread of the Coronavirus/COVID-19 through the adoption of the WC - SCP COVID Health & Safety Plan. By executing this instrument, the undersigned acknowledges that he/she has read the WC - SCP COVID Health & Safety Plan and agrees to abide by the provisions of the plan and consents to the use and disclosure of medical testing and information obtained as required in the plan. The WC - SCP cannot guarantee that the student athletes, coaches, and staff members will not become infected with the Coronavirus/COVID-19 and the undersigned understands that the risk of exposure to or infection from the Coronavirus/COVID-19 may occur despite the precautions taken pursuant to the plan. For these reasons, the undersigned, as a condition of participation in WC - SCP programs, hereby releases and agrees to hold harmless WC - SCP and its officers, members and staff from, and hereby waives, any and all causes of action, claims, damages, costs, and expenses arising from Coronavirus/COVID-19 exposure or infection in connection with participation in WC - SCP programs. *

I Agree

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IN THE EVENT OF A COVID-POSITIVE PLAYER:This question is required. *ANY PLAYER, COACH, STAFF MEMBER OR SPECTATOR WHO TESTS POSITIVE FOR COVID-19 OR IS GIVEN THE DIAGNOSIS OF COVID-19 WITHIN 7 DAYS OF VISITING THE WC - SCP CAMPUS MUST NOTIFY DIRECTORS Jeff Eisele at info@tsesoccer.com OR Joe Leggour at joe@scpfc.com.This information will be used for contact tracing within the WC - SCP. Additionally, any affected non-WC - SCP teams or individual players will be notified. Please note: for reasons of privacy and confidentiality, we will not share the name of the player directly impacted. *

I Accept

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Parent: please sign your name here.This constitutes a legally binding signature in observance of the terms and conditions laid out in this form.*Parent - please fill this out if your child is a minor. *

Todays Date *

YYYY

Parent: please enter your phone number here.*Parent - please fill this out if your child is a minor. *

Players Name *

Players DOB *

YYYY

Do you have a fever or have you experienced a fever within the past 14 days? *

Yes

Have you experienced a recent onset of respiratory problems, such as a cough or difficulty in breathing within the past 14 days? *

Yes

Have you, within the past 14 days, traveled outside the country? *

Yes

Have you come into contact with a person with confirmed Covid 19 infection within the past 14 days? *

Yes

What to do in the case of a possible infection or report of player/coach testing positive? Individuals:· If you are experiencing symptoms, do not attend league games ·If you are experiencing symptoms during a league game, immediately leave the facility and self-quarantine ·Immediately notify your team and club officials ·Seek professional medical advice and see a medical professional, if necessary, to get testedTeams and Clubs:· Notify your Club Officials/Safety Officer and EDP Soccer officials, then cooperate with any mitigation and contact tracing protocols ·Notify your local/state health officials and cooperate with any mitigation and contact tracing protocols· As required by local/state health and safety tracing guidelines, Your entire team and coaches should self-quarantine for 2 weeks and not participate in any organized competitions · Any players/coaches/teams that may have come into contact with a potentially infected individual may be notified, and asked to self-quarantine or get tested for COVID-19 *

I understand the information provided.

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