BC Fire Soccer Club
2021-2022 Try-Outs
COVID-19 Testing Compliance

BC Fire Soccer Club 2021-2022 Try-Outs COVID-19 Testing Compliance

Player’s Name: __________________________________________________

Gender: ________________

Birth Year: ______________

Please select one of the 2 options below:

1. I have tested negative for COVID-19 at a local vendor on or after June 6, 2021. Testing Facility: ________________________ Test Date: ______________

2. I meet the definition of fully vaccinated as defined by the following criteria: – It has been 2 weeks since your second dose in a 2-dose vaccine series. (Example: Pfizer or Moderna) – It has been 2 weeks since receiving your single-dose vaccine. (Example: Johnson & Johnson) Final Vaccination Date: ____________________________________________

Parent Signature: ____________________________ Date: ______________