OSRA SEPT WARMUP SKATES Health Check
This form will need to be filled out 8 hours before every Ice time.
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Date *
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Division *
Required
Player/Instructor (Last, First) *
Email *
Contact Phone number *
Home Association *
PLAYER/INSTRUCTOR- Have you exhibited any of the following symptoms related to COVID 19? Are you currently experiencing one or more of the symptoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions. Do you have one or more of the following symptoms? For example: • 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 smell or taste • (For adults > 18 years or older) Fatigue. lethargy, malaise and/or myalgias • (For children < 18 years) Nausea, vomiting and/or diarrhea *
PLAYER/INSTRUCTOR - Have you traveled outside of Canada in the last 14 days, or have you come in close contact with a person who has a confirmed case of COVID 19? *
Required
SPECTATOR attending (Name and Contact information)
SPECTATOR - Have you exhibited any of the following symptoms related to COVID 19?  Are you currently experiencing one or more of the symptoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions. Do you have one or more of the following symptoms? For example: • 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 smell or taste • (For adults > 18 years or older) Fatigue. lethargy, malaise and/or myalgias • (For children < 18 years) Nausea, vomiting and/or diarrhea
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SPECTATOR - Have you traveled outside of Canada in the last 14 days, or have you come in close contact with a person who has a confirmed case of COVID 19?
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