COVID Screening form for Surrey Female Volunteers

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is to be filled out prior to every ice session; however if you have been in contact with others that have travelled or covid tested people who are awaiting swab results during the course of this camp we ask that you immediately self-identify and speak with the appropriate person at the association or connect with the division_director@surreyfalcons.ca

Email *

Have you or anyone traveled outside of Canada in the last 14 days *

Yes

Have you, or has anyone in your household been in contact in the last 14 days with someone who is being investigated or who has a confirmed case for COVID-19? *

Yes

Are you currently being investigated as a suspect case of COVID-19? *

Yes

Have you tested positive for COVID-19 in the past 10 days? *

Yes

Please sign below of confirmation of the information below *

Clear form

Never submit passwords through Google Forms.

This form was created inside of Surrey Female Hockey Association. Report Abuse

Forms