Date*

Players Name*

Age Group
SelectLittle Warriors Under 5 Under 6 Under 7 Under 8 Under 9 Under 10 Under 11 Under 12 Under 13 Under 14 Under 16 Girls Under 12 Girls Under 15 Girls Under 19 Touch

Email Contact*

Mobile Contact*

Are you currently diagnosed with, or believe you may have COVID-19?*:

YES

NO

Have you had any of these symptoms of COVID-19 in the past 7 days?

High Temperature (Fever)?*:

YES

NO

A new continuous cough?*:

YES

NO

New unexplained shortness of breath?*:

YES

NO

Loss of taste or smell?*:

YES

NO

Have you been in contact with a COVID-19 confirmed or suspected case in the previous 7 days?*:

YES

NO

MAYBE

Name of Parent/Guardian*