2021 Spring Lacrosse COVID-19 Disclosure Form

Please fill out the form below before every practice and game. It is required for your child to participate in CYL lacrosse activities TODAY. It is important that you disclose whether you have experienced any recent symptoms associated with COVID-19 or think that you might have been exposed to it. Disclosure forms are valid for 24 hours.

Be sure to review our CYL COVID Safety Guidelines for the season.

A weakened or compromised immune system from a current disease, medical condition, or underlying ailment, can put you at greater risk for contracting COVID-19. We would rather have you sit out a few sessions than to get sick...

If your athlete or anyone in your household displays COVID-19 symptoms within 48 hours after a CYL lacrosse practice or game, please notify us immediately, so that we can relay to families, the City, and the Cambridge Public Health Department.

For information on testing, please see The City of Cambridge's Testing Resources webpage.

Practices and games are available to ALL HEALTHY 2021 CYL-registered players!

1. Enter Parent Contact Information

Parent Full Name Enter parent's full name!

Parent Phone Number Enter valid parent phone number!

Are you a coach?

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2. List family members participating on:

Athlete(s) Last Name Enter valid family name!Verify the names and grades(0-8) of your athletes!

First Names of Athletes Playing GIRLS Lacrosse

First Names of Athletes Playing BOYS Lacrosse

* Same sex twins can be entered comma separated in a single text field - i.e., Jane, Jill

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3. COVID-19 Health Status Disclosure

1. Have you or someone in your household tested positive for, or been diagnosed by a healthcare provider, with COVID-19 within the past 10 days?

Yes NO
Please Answer!

2. Have you or someone in your household been advised by a health care provider of a public health agency to self-quarantine within the last 14 days?

Yes NO
Please Answer!

3. Have you or someone in your household had close contact with someone experiencing symptoms, or someone with known exposure to COVID-19?

Yes NO
Please Answer!

4. Have you or anyone in your household newly experienced any of the following symptoms that cannot otherwise be attributed to another condition?

• Loss of taste or smell
• Shortness of breath or difficulty breathing
• Headache
• Cough
• Sore throat
• Chills
• Fatigue
• Muscle pains or aches
• Nausea, vomiting or diarrhea
• Runny nose or congestion

Yes NO
Please Answer!

5. Do you agree to wear a face covering or mask (... where required) while engaging in CYL activities?

YES No
Please Answer!

6. Do you agree to adhere to all rules and protocols of social distancing while engaging in CYL activities?

YES No
Please Answer!

COACH, you didn't list any participating family members with your disclosure. If this is an error, click here to ADD your athletes!

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To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect information can be dangerous to the health of our athletes and families. It is my responsibility to inform Cambridge Youth Lacrosse of any changes in medical status.

YES, Please use cookies to speed up my data entry next time!

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