Weekly Health Screening for BP Indoor Soccer
EVERY INDIVIDUAL entering the soccer dome for BP indoor soccer from 5-6pm on Monday evenings must complete this waiver before 3pm on the day of programs.
If a parent is accompanying their athlete into the dome, they are responsible for completing 2 separate waivers: 1. For athlete
2. For accompanying parent
If this form is not completed by 3pm on the day of programs, you will not be able to participate in that week's programs.
We ask you to please be considerate and adhere to this precaution in order to keep all athletes, families and volunteers safe.
Do you have a temperature of 100* or higher?
In the past 14 days have you traveled internationally or to any of the following states? ***As of October 13, 2020, the following states and territories meet the criteria for required quarantine: Alabama, Alaska, Arkansas, Colorado, Delaware, Florida, Georgia, Guam, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming. (This is based upon a seven day rolling average, of positive tests in excess of 10%, or number of positive cases exceeding 10 per 100,000 residents.)***
In the last 2 weeks did you have contact with someone who was diagnosed with COVID 19?
Have you had any of the following symptoms in the last 48 hours?
Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
Congestion or runny nose
Nausea or vomiting
New or worsening cough
By checking this box I am confirming the above information is accurate. PLEASE NOTE: If you answered "Yes" to any of the questions outlined above (Questions 5-6), do not report to programs and contact Mary at
as soon as possible.
I agree that all of the above information is true and accurate.
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