Millbrook Skating Club - Wednesday Health Screening

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This mandatory health screening is in effect for our 2021-2022 skating season. All program participants are required to complete this health screening before entering the Cavan Monaghan Community Center for their skating session. If a program participant does not pass the health screening (i.e. they have minor flu-like symptoms) they can still participate in the session if they show a negative COVID-19 test. This health screening will be used to track session attendance.

Skater's Name *

S Archer

H Bayes

L Bedard

R Bull

R Bridal

S Davis

E Davenport

E Cone

E Cullen

J Cullen

N Cullen

L Davidson

M Davidson

C Davis

M Dundas

Ph Earl

Pe Earl

B Fallis

H Helleman

D Hines

S Hudson

M Hunt

E Jackson

C Jessup

E Jessup

N Lamothe

B Mahaffy

S Malcolmson-Bonello

S Martinez

I Martinez

N Matthews

A Mayne

E McGee

F McGee

M McGee

M McLean

H Moloney

Z Nguyenho

W Perrin

H Richard

H Robertson

J Robertson

B Seeley

A Simpson

S Simpson

L Sutton

B Sweeting

T Swift

I Todd

L Todd

C Ward

K Watchorn

E Whittington

In the past 10 days, have you or anyone you are living with experienced fever, new onset of cough or worsening of chronic cough, new or worsening shortness of breath, new or worsening difficulty breathing, sore throat, or runny nose that is not related to a pre-existing illness or health condition?

YES

Clear selection

Do you have chills, painful swallowing, stuffy nose, headache, muscle or joint ache, are feeling unwell, have fatigue or severe exhaustion, nausea, vomiting, diarrhea, unexplained loss of appetite, loss of sense of smell or taste, or conjunctivitis (pink eye)?

YES

Clear selection

In the past 14 days, did you return from travel outside of Canada, or did you have close contact with someone who is confirmed as having COVID-19?

YES

Clear selection

Has your health care provider told you to self-isolate?

YES

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Are you fully vaccinated? Please note that all guardians, volunteers, coaches, and skaters 12 years and older are required to provide Ontario's vaccination status QR code and I.D. before entering the facility as outlined by Peterborough Public Health unless there is a valid exemption. Please review our COVID-19 Health and Safety protocols available on our website for proof of vaccination guidance and valid exemption categories.

YES

N/A - Skater is under 12 years of age

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Submit

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