WSSL COVID-19 Caregiver Health Questionnaire Fall 2021
Version : 9/12/2021

This form should be used if anyone will accompany your child to a practice or game who is not listed on your WSSL inLeague Account (each is referred to for this purpose as a "caregiver"). The person that is accompanying the child must fill out the form and sign it.

AT LEAST 2 HOURS BEFORE THE START TIME OF EVERY PRACTICE OR GAME, please:
1) have the CAREGIVER take their temperature; and
2) complete this questionnaire.

It is important to be honest in completing this questionnaire. It will assist us in trying to keep all of our families safe. IT IS ALSO IMPORTANT TO COMPLETE THIS QUESTIONNAIRE ON THE SAME DAY AS THE PRACTICE OR GAME (DO NOT COMPLETE THE NIGHT BEFORE).

If any of the information changes, it is your responsibility to immediately notify us at covidreporting@wssl.org.
Email *
Today's Date *
MM
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DD
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Full Name of Caregiver *
Full Name of Child Caregiver is accompanying
Program
Clear selection
Team Name (e.g., B10 Gold, G12 Blue, B8-F, etc.) *
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