Online Covid 19 Assessment, U7 Blackhawks (Otonabee Minor Hockey)

Print Online Covid 19 Assessment
Please read through the questionnaire and answer all of the questions. Please answer all questions accurately. Players who arrive at activities and appear to be symptomatic will not be allowed to participate. If your player is not feeling well, or showing any signs of any illness please keep them home. If you have any symptoms or answer yes you must stay home for a minimum of 24 hours after the last symptom subsides. You are given 2 options on the form: *PASS - answered "NO" to all questions and players are permitted to participate *FAIL- answered "YES" to any of the questions and players are NOT permitted to participate. Please notify Coach if your child is not attending and the reasons for missing, this is for tracking purposes.
Player Identification - U7 Blackhawks Only
  1. A copy of your form submission will be sent to this address as confirmation
Are you Currently Experiencing any of these issues?
Call 911 if you are experiencing any of the below symptoms
Self Assessment
Choose any/all symptoms that are new, worsening and not related to other known causes or conditions.
Are you in any of these at-risk groups
see below
In the last 14 days, have you been in close physical contact with someone who currently have Covid-19
This includes getting a Covid Alert exposure notification. Close physical contact means: 1) being less than 2 metres away in the same room, workspace or area 2) Living in the same house 3) Being in the same classroom
In the last 14 days, have you been in close physical contact with someone who either:
Please select Yes or No
Have you travelled outside of Canada in the last 14 days?
Please select Yes or No
Human Validation
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Printed from otonabeewolves.com on Thursday, October 29, 2020 at 3:27 PM