NVSC COVID 19 Notification Form
Please complete the following form so NVSC can submit the information to the PWC Department of Health and to ensure sufficient information for contact tracing if necessary. Please submit a separate form for each player in your household affected. All information will be kept confidential and will only be shared with appropriate staff to ensure sufficient tracking.
Name of person submitting form
Player FIRST Name (submit a separate form for each player in your home)
Player LAST Name
Player's Coach / Team
My Player was.....
diagnosed with COVID 19 (please provide date of diagnosis below)
exposed to someone diagnosed with COVID 19 (please provide date range for exposure below)
is suspected of having COVID 19 by a doctor (please provide date you were notified of suspected COVID 19)
Date of diagnosis / exposure range / symptoms
Please provide any additional information you think relevant.
Send me a copy of my responses.
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