Field of Play Screening Form
Please provide the following information prior to each session attended.
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Self-isolation requirements (NS government's restrictions and guidance):
Self-isolation requirements (NS government's restrictions and guidance):
Last Name *
First Name *
Skating Season *
Role *
Skating Session  - Date/Time *
Location *
Are you and/or someone from your household required to self-isolate based on the described above Nova Scotia public health self-isolation requirements? *
If yes, the skater is not permitted to attend any HSC sessions until the end of the self-isolation period.
In the past 48 hours have you had, or are you currently experiencing, any of these symptoms? *
If yes, the participant is not permitted to attend HSC events until symptoms have disappeared or a negative COVID-19 test is provided.
Yes
No
A fever (i.e. chills/sweats) OR Cough (new or worsening)
Two or more of the following symptoms (new or worsening) - Sore throat, Runny nose/nasal congestion, Headache, Shortness of Breath
Do you feel unwell today? *
If yes, the participant is not permitted to attend HSC session.
Required
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