EmailMe Form - COVID-19 | Reporting a Positive Test

Your Name *

First Last

Email address *

Your best phone # *

### - ### - ####

Name of Your Club *

Your position in your club *

I have been authorized to submit this report on behalf of my club *

Player

Coach

Other

Date positive test was confirmed for this person *

MM / DD / YYYY

Associated Team(s) Info

We need information about which team(s) the person who tested positive is rostered to or associated with

Team #1 Name *

Team #1 Age Group *

Player

Coach

Other

Person who tested positive is a *

Player

Coach

Other

Team #1 - Most recent date the person had contact with the team *

MM / DD / YYYY

List all opponents Team #1 came into contact with in the 7 days prior to the date the person tested positive and/or developed symptoms

If none, enter "N/A" *

League game, friendly or scrimmage, tournament game, festival game, etc....

If person on more than one team, complete this section

Team #2 Name

Team #2 Age Group

Player

Coach

Other

If person on more than one team, complete this question

Person who tested positive is a

Player

Coach

Other

Team #2 - Most recent date the person had contact with the team

MM / DD / YYYY

If person on more than one team and also had contact with this team, complete this question

List all opponents Team #2 came into contact with in the 7 days prior to the date the person tested positive and/or developed symptoms

If none, enter "N/A"

League game, friendly or scrimmage, tournament game, festival game, etc....