WCP Youth Teams Health Check Form
You must complete this within 24 hours of 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.
Player's First Name
Player's Last Name
Player's Team Name
2008 Boys Blue
2008 Boys Orange
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?
In consideration of being allowed to participate in any way in World Class Premier Corp programs, related events, and activities, I the undersigned, on behalf of myself and my participating children or guardians, acknowledge, appreciate, and agree that: I am aware there are risks to me of exposure to directly or indirectly arising out of, contributed to, by, or resulting from an outbreak of any and all communicable disease, including but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19) and/or any mutation or variation thereof. Participation in World Class Premier Corp programs, events, and activities involves the potential exposure to, and illness from infectious, communicable diseases, including COVID-19. While following Federal and State guidelines, World Class Premier Corp’s “Return to Play” Guidelines, and World Class Premier Corp’s COVID-19 Protocol may reduce the risk, the risk of serious illness and death does exist. World Class Premier Corp cannot, and does not guarantee, warrant, or represent that participants will not contract a communicable disease, including but not limited to COVID-19, as a result of participation in its programs, events, or activities. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, hold harmless, and forever discharge World Class Premier Corp, its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, liability, rights, or causes of action of whatsoever kind arising out of, or in any way connected to or related to any illness, injury, disability, damages or death I may suffer or sustain as a result of my participation in World Class Premier Corp programs, events or activities, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, ACKNOWLEDGE THAT IT CONSTITUTES A BINDING AGREEMENT AND PROMISE, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, even if arising from the negligence of the Releasees, to the fullest extent permitted by law.
I am clicking this in representation of my signature.
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of World Class Fubtol.