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Declaration Of Compliance Covid 19 Form -Form Fill

Section One
Q1

Name of Participant*

First Name
Q2

Name of Participant*

Last Name
Q3

Dixie SC Team Name*
Q4

Name of Parent/Guardian Completing the Declaration (for participants under the age of 18)*

First Name
Q5

Name of Parent/Guardian Completing the Declaration (for participants under the age of 18)*

Last Name
Q6

Phone Number*

Phone Number
Q7

Email*
Q8

Signature of Parent/Guardian (if the participant is under the age of 18)
Q9

Signature of Participant (if the participant is 18 years or older)
Q10

Date signed*

Date