Online Covid 19 Assessment, U8 Black Tier 2 - Scott (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 - U8 Black Tier 2 Only
  1. First and Last Name
  2. First and Last Name
  3. A copy of your form submission will be sent to this address as confirmation
  1. Call  911 if you are experiencing any of the following symptoms:

    - Severe difficulty breathing
    - Severe chest pain
    - Feeling confused or unsure of where you are
    - losing consciousness
Self Assessment
Choose any/all symptoms that are new, worsening and not related to other known causes or conditions.
  1. Personal information is collected under the authority of the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020, Ontario Regulation 364/20. 

    The information will be used to screen for COVID-19 risk factors prior to entering a County of Peterborough facility or participating in a hockey program.

    In the event of a confirmed COVID-19 diagnosis that coincides with your visit, by completing and submitting this form, you consent to the Otonabee Minor Hockey COVID-19 Coordinator sharing your name and contact information with Peterborough Public Health, for purposes of contact tracing to reduce the spread of COVID-19.
Human Validation
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Printed from otonabeewolves.com on Saturday, April 17, 2021 at 1:51 AM