COVID - 19 Self - Assessment This form must be filled out every week prior to entrance into the facility! COVID-19 Self - Assessment FormPlease complete the following questions before coming to the arena!Please enable JavaScript in your browser to complete this form.Parent / Guardian Name *FirstLastPlayers Name *FirstLastEmail *Date / Time *DateTimePhone *Do either of you have any of the following symptoms? *FeverCoughDifficulty breathingSore throat / Trouble SwallowingRunny noseLoss of taste or smellNot feeling wellNausea, vomiting, diarreah I have no symptomsIn the past 14 days, have either of you been in close contact with someone who is sick or has confirmed COVID-19, without wearing appropriate PPE? *YesNoHave either of you returned from travel outside Canada in the past 14 days? *YesNoIf you answered YES to any of these questions or have any of the listed symptoms, please stay at home & self-isolate right away. Call your health care provider or go to an assessment centre to find out if you need a COVID-19 test.Submit
