COVID-19: Return to Club Attestation
This form is to be used by individuals or parents/guardians (for participating children/youth) who have been absent due to a symptom of COVID-19 or in contact with a person from their household who is experiencing a symptom of COVID-19.
If you have more than one child who was absent, please complete one form per child.
Individual Full Name (use child/youth’s name if filling out on their behalf): *
Date sent home from the Club, or was absent from Club starting on: *
By submitting this form, I agree and confirm that all of the listed criteria have been met for at least ONE of the following situations: *
Please confirm that the individual would pass the current screening process to attend the Club: *
Full Name of individual completing this attestation: *
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