Ramblers Team COVID-19 Screening

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Safety First for all Players, Coaches and Families

Competitive Team *

First and Last Name *

Are you currently experiencing any of these symptoms? *

Fever and/or chills (temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher)

Cough or barking cough (croup)

Shortness of breath

Decrease or loss of taste or smell

None of the above

Required

Are you currently experiencing any of these symptoms? *

Sore throat or difficulty swallowing

Runny or Stuffy/congested nose

Headache that's unusual or long lasting

Nausea, vomiting, and/or diarrhea

Extreme tiredness that is unusual or muscle aches

None of the above

Required

In the last 14 days, have you travelled outside Canada and been told to quarantine(per the federal quarantine requirements) *

Yes

In the last 14 days, has a public health unit identified you as a "close contact" of someone who currently has COVID-19? *

Yes

Has a doctor, health care provider, or public health unit told you that you should currently be isolating(staying home)? *

Yes

In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? (if you already went for a test and got a negative result, select "No")? *

Yes

If you answered “NO” to all questions, your child may participate because they seem to be healthy and have not been exposed to COVID-19.

If you answered “Yes” to any of these questions, please contact your doctor and do not attend any basketball activities.

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