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Team Health Self-Attestation Form

Welcome to the new Health Self-Attestation Form. 

If your child has tested positive for COVID-19, or has had close contact with someone who has tested positive, please complete the COVID-19 Report Form 

The undersigned, on behalf of the player identified below, hereby represents, warrants and acknowledges that I have read and understand my responsibilities as a Parent/Guardian according to the South Loudoun Basketball Return to Play guidelines, prior to participating in any South Loudoun basketball related activities. This includes, but is not limited to, individual or team practices, clinics, training, games, tournaments, meetings or classes. 

I attest that the information I am providing is true and accurate. Prior to bringing my player to participate in any basketball related activities that they have not experienced any of the following symptoms within the last 48 hours.

Please use the Team Code to indicate which team.  You can also type in the Coach's last name to try and find the team.

Today or in the past 48 hours, have you or any household members had any of the following symptoms?

Fever of 100.4ยบ or above, felt feverish, or had chills? Temperature must be taken before each practice/game.
Cough?
Sore throat?
Difficulty breathing?
Gastrointestinal symptoms (diarrhea, nausea, vomiting?)
Abdominal pain?
Unexplained rash?
Fatigue?
Headache?
New loss of smell/taste?
New muscle aches?
Any other signs of illness?
Fatigue alone will not excuse a child from participating.
In the past 14 days, have you had close contact with a person who has had a confirmed case of COVID-19?
Close contact is defined as being within 6 feet of an individual who has tested positive for COVID-19 for more than 10 minutes while that person was symptomatic, starting 48 hours before their symptoms began until their isolation ends.
Sign above

If the participant has answered yes to any of the above the participant will not be allowed into the facility for training.