I affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms of COVID-19, including, but not limited to, cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell WITHIN THE LAST 14 DAYS.

I affirm that I, as well as all household members, do not have any pending COVID-19 test results.

I affirm that I, as well as all household members, have not been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.

I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.

I affirm that I, as well as all household members, have not traveled outside of the country, or to any city considered to be a “hot zone” for COVID-19 infections WITHIN THE PAST 14 DAYS.

I understand that neither Waterford Street Football nor Villa FC can be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each player.