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.
Email address *
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..... *
Date of diagnosis / exposure range / symptoms *
Please provide any additional information you think relevant.
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