This form should be filled out if an MBA player or coach has COVID-19 symptoms, a positive COVID-19 test result (even if no symptoms) or has been close contact exposed to a positive case of COVID-19. 
Depending on the circumstance (symptoms, positive test result or close contact exposed) 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). Leave questions blank if the question does not apply to the situation. 
Note:  If you were informed by MBA that your child was exposed to COVID-19 through an MBA event, you do NOT need to complete this form.   

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* 1. Name of the Participant (the MBA player or MBA coach) about whom this form is being completed; subsequent questions refer to that Participant

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* 2. Name of the person completing this form on behalf of the Participant (e.g. the MBA player's parent/guardian completing the form about their child or the MBA coach completing the form about themselves)

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* 3. email address for the person completing the form

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* 4. Cell phone number for the person completing the form

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* 5. Grade level of the Participant

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* 6. Program the Participant is a part of

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* 7. Type in the name of head coach for the Participant's team

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* 8. What COVID-19 symptoms is the Participant experiencing? (if no symptoms leave blank)

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* 9. What date did the Participant's symptoms begin? (if no symptoms type leave blank)

Date

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* 10. What date was the Participant's COVID-19 test was taken (MM/DD/YYYY)?  (Leave blank if test not taken)

Date

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* 11. What date was the Participant's COVID-19 test result received (MM/DD/YYYY)?  (Leave blank if no test result)

Date

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* 12. Participant's COVID-19 test result was:

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* 13. What is the date that the Participant was Close Contact Exposed to a Positive Case of COVID-19 (MM/DD/YYYY)?  (If not reporting close contact for the Participant, then leave blank.)

Date

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* 14. What is the last date that the Participant had contact with their MBA team (MM/DD/YYYY)?

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