This form should be completed if a player or coach has COVID-19 symptoms, has as positive test result for COVID-19  (even if no symptoms) or has been in "close contact" to a positive case of COVID-19.

Depending on the circumstance (symptoms, positive test result or close contact exposure), some of the questions may not apply to your situation (for example, your child may not have taken a COVID-19 test at the time you complete this form).  Please fill out all of the applicable information but leave questions blank if the question does not apply to the situation.

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* 1. Date of report

Date

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* 2. Name of Parent/Guardian (if reporting on behalf of a Player)

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* 3. Name of Player

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* 4. Player's School 

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* 5. Name of Coach (if coach is making a report on his or her own behalf)

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* 6. Player or Coach's Date of Birth

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* 7. Your email and/or phone number

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* 8. Any symptoms?

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* 9. First Date of Symptom(s)

Date

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* 10. Date of COVID-19 Test Taken

Date

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* 11. Date of COVID-19 Test Result Received

Date

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* 12. Test Result

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* 13. Date of Close Contact

Date

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* 14. Team Name (e.g., Girls 5A)

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* 15. Last Date of Contact with Team

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