Screening | Soccer Alaska

Hello! Under order of the Municipality of Anchorage, you’ll need to answer these questions and record your name and phone number before you can participate in a game.

Have you been outside Alaska since June 10th, 2021?*

Yes
No
Yes, but I have proof of a negative COVID-19 test result taken at least 7 days after I entered Alaska

Have you been in contact with anybody with a suspected or confirmed case of COVID-19 since June 10th, 2021?*

Yes
No

Are you currently experiencing any of these symptoms? Cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea, or sore throat?*

Yes
No

Have you had a fever in the last 72 hours?*

Yes
No

Sorry, but under Municipal Order EO-09, you are not allowed to participate in a game at this time.

Name*

First Last

Phone*

Email*

Please enter your primary e-mail address. We will only use it to contact you with important safety information concerning COVID-19 exposure at The Dome - not for any other purpose.

Age*

Soccer Alaska’s Waiver

Do you agree to Soccer Alaska’s Waiver?*

Yes, I agree.

USA Soccer Association’s Waiver

Do you agree to USA Soccer Association’s Waiver?*

Yes, I agree.

Do you affirm that you have an active 2021 Soccer Alaska Player Card? If caught playing without an active card, you risk a one-year suspension.*

Yes, I have an active 2021 Soccer Alaska Player Card

Consent*

Yes, I agree.

The User fully understands and appreciates both the known and potential dangers of utilizing the facilities, services, and programs of Soccer Alaska and acknowledges that use thereof by the undersigned may, despite Soccer Alaska’s reasonable efforts to mitigate such dangers, result in the exposure to COVID-19.