Saturday Recreational

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Required one per gymnast, every training day

What Class is your child and/or you attending?

Kindergym 9:00am

Girls 5/6 9:00am

Parent & Tot 9:30am

Boys 5/6 9:30am

Girls 7/8 9:30am

Kindergym 10:00am

Girls 5/6 10:00am

Parent & Tot 10:30am

Kindergym 10:30am

Kindergym 11:00am

Girls 5/6 11:00am

Boys 7/12 11:00am

Parent & Tot 12:00pm

Girls 7/8 12:00pm

Kindergym 12:30pm

Girls 5/6 12:30pm

Girls 7/8 1:00pm

Intermediate 9/12 1:00pm

Kindergym 1:30pm

Girls 5/6 1:30pm

Advanced 7/8 1:30pm

Other:

Clear selection

Is the participant *

Fully vaccinated agianst COVID-19

Aged 11 or younger

Neither

This screening is for the training day selected below *

YYYY

LAST name of Gymnast (the participant) *

FIRST name of the Gymnast (the participant) *

Name of person completing this screening *

Do any of the following apply to the participant? *

In the last 14 days, I travelled outside of Canada and was told to quarentine - Please do not come to gymnastics, and self isoalte

In the last 14 days, I travelled outside of Canada and was told to not attend school/child care - Please do not come to gymnastics, and self isolate

Someone you live with returned from outside of Canada and is isolating while waiting for COVID-19 results - Please do not come to gymnastics, and self isolate

None of the above

In the last 5 days, has the participant tested positive for COVID-19? *

Yes - Please do not come to gymnastics, and self isolate

Do any of the following apply to the participant? *

You live with someone who is currently isolating because of a positive COVID-19 test - Please do not come to gymnastics, and self isolate

You live with someone who is currently isolating because of COVID-19 symptoms - Please do not come to gymnastics, and self isolate

You live with someone who is waiting for COVID-19 test results - Please do not come to gymnastics, and self isolate

Has a doctor, health care provider, or public health unit told the participant that they should currently be isolating? *

Yes - Please do not come to gymnastics, and self isolate

In the last 5 days, has the participant been identified as a "close contact" of someone who tested positive for COVID-19 or has symptoms of COVID-19? *

Yes - Please do not come to gymnastics, and self isolate

Does your the participant have any of the following symptoms? *

Fever (feeling hot to the touch, a temperature of 37.8 degrees Celsius or higher)

Chills

Cough that is new or worsening (continious, more than usual)

Barking cough, making a whistling noise when breathing (croup)

Shortness of breath (out of breath, unable to breathe deeply)

Lost of taste or smell

Digestive issues (nausea/vomiting, diarrhea, stomach pain)

NONE OF THE ABOVE

Required

I ackowledge that if I selected any of the above symptoms, I will not send my child (the participant) to Gemini's facility and will notify the Recreational Director (recdirector@geminigymnastics.com) with the reason for their absence. I will also call the Durham Region Health Department 905-668-7711 for further instructions. *

I acknowledge the protocol

Required

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