WATERLOO RINGETTE DAILY COVID-19 ATTESTATION AND AGREEMENT

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Only complete if it is less than 8 hours before your event

Please read this form carefully. This form must be completed prior to every practice, game, dryland training, team meeting, event or other sanctioned ringette activity.

When in doubt, please have your player/participant stay home, get tested or seek medical advice.

Email *

This forms is being completed for the following:

U8 Practice

Player/Participant: *

For Questions 1-6 and Statements 1-3, the "Participant's" answers are: *

YES - I attest and agree that all of the statements in the form above are true.

NO - I/my player/participant need(s) to self-isolate and/or contact public health as one or more of the questions 1-6 apply or I choose not to abide by statements 1-3.

For Questions 1-6 and Statements 1-3, he parent's/guardians answers are: *

YES - I attest and agree that all of the statements in the form above are true.

NO - I/my player/participant need(s) to self-isolate and/or contact public health as one or more of the questions 1-6 apply or I choose not to abide by statements 1-3.

Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *

Yes

In the last 14 days, has anyone in your household travelled outside of Canada? *

Yes

Name of driver/parent/guardian *

DIGITAL SIGNATURE - from Participant or Parent/Guardian of Minor (Type your First and Last Name): *

Date of Event: *

YYYY

If your answers for questions 1-6 in the attestation are positive for COVID19 exposure, please do not come to practice or the WRA event. Help us to protect our players, coaches, officials, parents and all others in our community by preventing the spread of the disease. Contact public health or complete the Ontario Coronavirus Self-Assessment Questionnaire if your player/participant has symptoms: https://covid-19.ontario.ca/self-assessment/

THANK YOU!

Send me a copy of my responses.

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