Pre-Premier Academy Health Check Form
You must complete this form before every training session in order to participate.

Please review the following important items:

1. Participation in any group activities is only allowed if:
a. You have had no signs or symptoms of COVID-19
b. No signs/symptoms that may have been COVID-19
c. Have not been exposed to someone who has had signs or symptoms of COVID-19 for a minimum period of 14 days before participation.
- If any of the above are applicable, a note from your child's healthcare provider is required stating that they are cleared to participate in soccer related activities.
d. Your child has not had a temperature greater than 100.4 in the last 24 hours.

3. If you are sick or feel sick, STAY HOME.

4. At risk individuals, youth or adult, STAY HOME (if you are unsure if you, or your child, are considered at risk, please consult your medical provider directly).

5. If you have been in close contact (within 6 feet) with someone who is suspected or
confirmed to have COVID-19:
a. Begin self-quarantine for 14 days.

6. Parents must advise your coach or club immediately if any possible exposures have occurred in your team or training.

For the health and safety of our players, families, and coaches, completion of this electronic form is required with the following guidelines:
a. Be sure to fill out a new form on the day of each training session.
b. Forms may be filled out starting at 5am on the day of the session up to 1 hour before the start of the session.
c. Forms cannot be completed at the field at the time of the training session.
d. Forms completed sooner than 2 hours before the training session will constitute a forfeiture of the player's opportunity to participate in that day's training session. In this instance, the player will not be allowed on the field at any point for the training session.
Email address *
Player's First Name *
Player's Last Name *
Today's Date *
MM
/
DD
/
YYYY
Parent/Guardian's First and Last Name (Coaches insert name here as well) *
Email Address *
Phone Number of best contact person *
The player has NOT had a temperature greater than 100.4 degrees over the past 24 hours? *
The player has NOT had any close contact with an individual who has had any symptoms related to COVID-19 or anyone with a confirmed case of COVID-19? *
The player is currently NOT demonstrating or suffering from any illness with symptoms such as coughing, shortness of breath, sore throat, congestion, nausea and vomiting, diarrhea, headache, muscle, joint pain, sudden loss of taste or smell, or chills? *
Our family will follow all social distancing rules stipulated by WCP's Return to Play Policy. *
Time of Training Session *
Time
:
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