PSRC - Dryland Training COVID-19 Screening

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Anyone attending dryland training (children and adults) with Parkland Ski Racers Club must complete this form prior to attending each dryland training session. Screening forms must be completed by a parent or guardian.

If you answer YES to any of the questions or are symptomatic, do not attend dryland training.

A SCREEN SHOT OF YOUR SCORE INCLUDING YOUR NAME AND DATE MUST BE SHOWN TO COACH TO PARTICIPATE IN TRAINING. Your score must be 100% (25/25) to participate in training.

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Name of participant *

Name of child or name of parent attending (1 form per person)

Today’s Date *

VVVV

Is this form being completed for *

A Child

A Parent/Guardian attending with child

Does the child have any new onset (or worsening) of the following core symptoms *

8 pistettä

YES

Fever (>38 degrees celsius)

Cough ( continuous, more than usual not related to other known causes or conditions such as asthma)

Shortness of breath (continuous, unable to breath deeply, not related to other known causes such as asthma)

Loss of sense of smell or taste (not related to other known causes or conditions like allergies or neurological disorders)

Does the child have any new onset (or worsening) of the following other symptoms: *

9 pistettä

YES

Chills, without a fever

Sore throat/painful swallowing

Runny nose/congestion

Feeling unwell/fatigued

Nausea, Vomiting and/or diarrhea

Unexplained loss of appetite

Muscle/joint aches

Headache

Conjunctivitis (pink eye)

In the past 14 days, have you had close unprotected contact with someone who is a confirmed COVID-19 case? *

2 pistettä

Yes

In the past 14 days, have you had close unprotected contact with someone who is awaiting COVID-19 Test results? *

2 pistettä

Yes

In the past 14 days, have you or anyone in your household travelled outside Canada? *

2 pistettä

Yes

I confirm that I have answered ‘No’ to all the above question and my child can participate in today’s program. *

2 pistettä

Yes

Name of parent/guardian completing form *

Lähetä

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