Coronavirus Reporting Form

Use this form if a KMBA player or someone in their household is exhibiting symptoms of or has tested positive for COVID-19. This information will be shared only with necessary individuals within KMBA for the purpose of notifying other players and families who may have been exposed.

KMBA will provide details only to the other players and families who may have been exposed. Details provided will only include whether the individual exhibiting symptoms is a player or member of the player's household. We will not share the name of the affected individual or family.

Who is completing this form?*

First NameLast Name

E-mail*

Select a Team*

Select the team you wish to support

Who is exhibiting symptoms?

PlayerCoachSomeone else close to the player/coach

Name of person exhibiting symptoms*

First NameLast Name

Does this person live with the player?*

YesNo

Type of case*

Suspected CaseConfirmed Case (positive test)

Notes