COVID-19 Exposure Report Form
AYSO Region 88 Glendale / La Crescenta / Montrose
If you as a Volunteer for Region 88, or your child as a player or volunteer for Region 88, have been exposed to a person who tested positive for COVID-19, please fill out this form and self-isolate as per guidelines.
For example, if a player has been notified by the school that there was a close contact or an exposure to a COVID case and that the player must self-isolate (quarantine), then please complete this form and honor the self-isolation as per L.A. County guidelines. The form will help us keep track of players and volunteers who are not available to participate due to self-isolation.
This report is for a:
Player or Youth Volunteer Name
Player's Division (Age Group)
U4 / 5U
Volunteer (Adult) Name
Cell Phone Number
Please enter a valid phone number.
Exposure / Symptoms
Please provide information regarding the player's or volunteer's symptoms currently being experienced.
Where did the exposure happen
School / University
Home (e.g. a family member)
Does the person exposed have any of the symptoms noted below
Please indicate the symptoms the affected person are currently having:
Shortness of breath
Loss of taste or smell
Muscel or body aches
Nausea or vomiting
Congestion or runny nose
No symptoms at this time
Has the affected person been fully or partially vaccinated against COVID-19?
Fully vaccinated with 2-doses for Moderna or Pfizer or 1 shot for J&J
Partially vaccinated with 1 dose of Moderna or Pfizer
Has someone from the team been notified of this COVID-19 diagnosis (including if the affected person is the players' parent)?
Should be Empty: