SCB - Soccer Health Questionnaire
This form is maintained and monitored by Mat Kelch only. If information is requested, I will personally contact you to ask your permission before submitting.


By submitting this form, you are confirming that all of the above information is accurate today.

If you answer "yes" to any of the screening questions, you are not permitted to attend any CYC game, practice, or event as a player, coach, volunteer, or spectator.

*If you have tested positive for COVID-19, are awaiting test results, or have had significant exposure to a positive COVID-19 individual, then you should not participate or attend. Parents are obligated to contact their Athletic Association to notify them of a positive diagnosis of COVID-19.

Submitted forms are valid for 48 hours. New forms will need to be submitted before each practice and game

Family Name *
Event *
Role *
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