PFA Pre-Participation Screening
We are adhering to strict safety guidelines and required by the state to collect the following information prior to allowing participation in our programs. MUST BE COMPLETED BY 5PM EACH SUNDAY TO PARTICIPATE IN THE SUBSEQUENT WEEK'S ACTIVITIES. Players who have not completed pre-screening will not be allowed to participate.
Child Name *
Parent/Gaurdian *
Phone contact *
Provide a number that we will be able to reach you at during the hours that your player is in our care.
Email contact *
People with these symptoms may have COVID-19

⚙︎ Fever or chills
⚙︎ Cough
⚙︎ Shortness of breath or difficulty breathing
⚙︎ Fatigue
⚙︎ Muscle or body aches
⚙︎ Headache
⚙︎ New loss of taste or smell
⚙︎ Sore throat
⚙︎ Congestion or runny nose
⚙︎ Nausea or vomiting
⚙︎ Diarrhea
Has your child or another family member been sick or showed possible COVID symptoms during the past 14 days? *
Has your child or another family member been in contact with an individual who have been sick or showed possible COVID symptoms during the past 14 days? *
If so, please explain.
Has your child or another family member traveled outside of Lane County during the past 14 days? *
If so, please state where and when you traveled.
I have read and will make sure my child knows the above Safety Rules for Players prior to participating. *
Required
I have read and will follow the above Safety Rules for Families. *
Required
I will take my child's temperature 30 minutes prior to arrival at the field and will keep her/him home if it is 100.4℉ or higher. *
Required
On each day of camp/training I will check my player in when dropping off and out when picking up using the Check-In and Check-Out contactless mobile forms. *
Required
I will notify Pelada FA staff immediately if my child or a family member develops possible COVID symptoms or becomes sick. *
Required
Thank you for helping us keep our families and community safe!
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