U16 UOVRA & RINGETTE ONTARIO DAILY COVID-19 ATTESTATION AND AGREEMENT Updated September 4, 2021

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Ringette Canada, Ringette Ontario and The Upper Ottawa Valley Ringette Association (UOVRA) are defined as the “Organization”.

By checking the Attestation and Agreement box below, the Participant or the Participant’s Guardian agrees that while attending or participating in the Organization's events or attending at the Organization’s facilities, the Participant:

1. Will follow the laws, recommended guidelines, and protocols issued by the Government of the Province in respect of COVID-19, including practicing physical distancing, and will do so to the best of the Participant’s ability while participating in the Organization's events or attending at the Organization’s facilities;
2. Will follow the guidelines and protocols mandated by the Organization in respect of COVID-19;
3. Will follow the guidelines and protocols mandated by the Facility in respect of COVID-19;
4. Will, in the event that the Participant experiences any symptoms of illness such as a fever, cough, difficulty breathing, shortness of breath or malaise, immediately:
a. inform a representative of the Organization; and
b. depart from the event or facility.

UOV will be using the Renfrew County District Health Units Daily COVID-19 Screening Tool for Businesses and Organizations (Screening Patrons) as a tool to detemine whether your child or yourself should be attending any UOV events.

Ministry of Health - COVID-19 Screening Tool for Businesses and Organizations (Screening Patrons)
Version 8: August 27, 2021

This tool provides basic information only and contains recommendations to support decision making by parents about whether their child or themselves should attend UOV events and/or needs to be tested for COVID-19. This can be used to assess symptoms of any child or individural who attends UOV events. It is not to be used as a clinical assessment tool or intended to take the place of medical advice, diagnosis or treatment. Screening must occur daily and at home before a child or individual enters any facility used for a UOV event.
When assessing for the symptoms below, you should focus on evaluating if they are new, worsening, or different from your child’s or your own baseline health status or usual state. Symptoms associated with known chronic health conditions or related to other known causes/conditions should not be considered unless new, different or worsening.

Under Privacy Regulations you have a right to access and correct any information about you.

By signing below, the Participant (named below) or the Participant’s Guardian attests that all questions have been answered truthfully and honestly.

Email *

Question 1a: Are you currently experiencing one or more of the sypmtoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions. *

Fever and/or chills

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)

None of the above

Required

Question 2: In the last 14 days, have you travelled outside of Canada AND been advised to quarantine (as per the federal quarnatine requirements? *

Yes

Question 3: Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *

Yes

Question 4: In the last 10 days, have you been identified as a "close contact" of someone who currently has COVID-19? *

Yes

Question 5: In the last 10 days, have you received a COID Alert exposure notification on your cell phone? *

Yes

Required

Question 6: In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit? *

Yes

Question 7: In the last 14 days, has someone in your household (someone you live with) travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirments) in the last 14 days? *

Yes

Question 8: In the last 10 days, has someone in your household (someone you live with) been identified as a "close contact" of someone who currently has COVID-19 AND advised by a doctor, health care provider or public health unit to self-isolate in the last 10 days? *

Yes

Question 9: Is anyone you live with currently experiencing any new COVID-19 symtoms and/or waiting for test results aftr experiencing symptoms? *

Yes

Results of Screening Questions

If you answered NO TO ALL QUESTIONS FROM 1 THROUGH 9, you can enter the arena. Once inside, you must continue to follow all public health measures, including masking, maintaining physical distancing and hand hygiene.

If you answered YES TO ANY QUESTION FROM 1 THROUGH 9, you are not permitted to enter the arena (including any outdoor or partially outdoor arenas). You are advised to go home to self-isolate immediately and contact your health care provider or Telehealth (1-866-797-0000) to get advice or an asessment, including if you need to get a COVID-19 test.

If you answered YES TO QUESTION 9, you are advised to stay home, along with the rest of the household, until the sick individual gets a negative COVID-19 test result, is cleared by the local public health unit, or is diagnosed with another illness.

CONTACT TRACING (second part of the form)

All players, coaches, officials, volunteers, and parents/guardians (who enter the facility) must be included in this log. The log can be electronic or completed on site by a responsible adult.

The information collected on this document is being collected to assist in the management of the COVID-19 pandemic. This information will be kept in a safe and secure location and will be provided to Public Health Authority on request if it is required for contact tracing purposes.

The Association and Team collecting this information will not use this information for any other purpose and will destroy this record after six weeks.

Under Privacy Regulations you have a right to access and correct any information about you.

*Required

Date of UOVRA Event *

YYYY

Participants Name *

The Parent / Guardian's Name if the Participant is a minor *

Participant / Guardian /Parent Contact Phone Number *

Who is dropping off and picking up Participant? *

Parent/Guardian Listed Above

No One - Participant is arriving by themselves

Other:

Required

If you answered OTHER to who is dropping off and picking up Participant, please write their Name and Phone Number below

Location of the Event *

Team Name *

U16

Attestation and Agreement *

By checking this box you attest and agree to follow UOVRA and Public Health Guidelines

Required

A copy of your responses will be emailed to the address you provided.

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