COVID Certification - Youth
In an effort to continue to provide a safe environment, you are strongly encouraged to complete this Certification on behalf of your child (the “Participant”) before s/he participates in any Big City Volleyball League LLC (the “Company”) activity.  
If possible, please take your temperature and the Participant’s temperature directly before traveling to the site. Do not come to the site if you and the Participant are not able to meet the health qualifications for entry.    
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Parent/Guardian's Full Name *
E-mail *
Participant's Full Name *
Phone Number *
STATEMENTS:  I have not been diagnosed with or tested positive for COVID-19 in the past 14 days. I have not in the past 14 days experienced any of the symptoms identified by the Centers for Disease Control as being associated with COVID-19 (i.e. fever of 100.4°F or above, chills, cough, shortness of breath/difficulty breathing, fatigue, muscle/body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and/or diarrhea).  I have not knowingly had close contact* with anyone (including household members, intimate partners and others) who has been diagnosed with, tested positive for, or experienced symptoms of COVID-19 in the past 14 days.  I have not returned in the past 14 days from any country or state that is currently subject to a mandatory quarantine order.* “Close contact” means being within 6 feet of such person for at least 10 minutes or having had direct contact with such person’s infectious secretions (e.g., being coughed on or having shared food/drink). Please check the appropriate box to indicate whether you agree with all of the above statements as of this date: *
Please check the appropriate box to confirm that you have been provided with the our Safety Protocols: *
I agree that if within forty-eight (48) hours after participating in any Big City Volleyball activity, Company property, or site or participation in any Company activity, I learn or have reason to believe that I or the Participant, or someone with whom I or the Participant has had close contact in the past 14 days, developed COVID-19 symptoms, tested positive for COVID-19, or was otherwise identified as a carrier of COVID-19, I will immediately inform the COVID Coordinator.  The Company will make efforts to keep your information as confidential as possible consistent with its requirement to engage in any contact tracing process and to advise others of any potential exposure to the virus. (Please insert your name and date of participation below; ex: John Doe, 9/1/2020) *
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