Player Vaccination status form
AYSO Region 88 Glendale / Per L.A. County Public Health Order January 2022
Parent or Guardian Name
*
First Name
Last Name
Primary Email
*
example@example.com
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Player Information
Please submit one (1) form per player
Player's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Vaccination Status
*
Fully Vaccinated
Unvaccinated and will provide test results each week
Tested positive more than 10 days ago, and less than 90 days ago (COVID immunity)
None of the above, I will contact you with my concern or provide a comment below
Proof of Vaccination
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Submission of Vaccination Proof
I wish to submit Vaccination proof in person
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