COVID - U7A Toronto (Ancaster Minor Hockey)

Print COVID - U7A Toronto
  1. Terms and Conditions:
    I acknowledge that I will submit this screener no earlier than 12 Hours of each scheduled session, prior to arriving at the arena.  I acknowledge that failure to do so may compromise my registration in the program.  
Session Information
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Participant Information
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Parent/Guardian Info
Please enter the name of the parent/guardian who will be dropping and or joining the participant at their session. ***ONLY 1 PARENT PER PARTCIPANT***
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  2. A copy of your submission will be sent to this email address

    e you currently experiencing any of these issues?  Cal91 if you  are. You cannot participate in on-ice or off-ice activities.  


    1.   Severe difficulty breathing
           (struggling for eacbreath, 
          can only speak in single words)


    2.   Sever chest pai(constant tightness o
          crushing  sensation)


    3.   Feeling confused or unsure of where you are


    4.   Losin consciousness


    If you are in any of the  following at  risk groups,
    w as that you speak with your physicia prio to participating:

    .  70 years old or older.

    2.  Getting  treatment  that  compromises  (weakens
         your  immune  system (for example, 
         chemotherapy, medication
    fo transplantscorticosteroids
    TN inhibitors)

        3.  Having a condition that compromises (weakens)
    you immune system 
    (for example, diabetes, emphysema, asthma,
              heart condition)

       4.   Regularly going to a hospital o
              healthcarsetting  for a treatment
             (foexample,dialysissurgery, cancer treatment)

  3. 1. Are you currently experiencing any of these symptoms?

    *Do you have a Fever? (Feeling hot to touch, temperature of 37.8C or higher) 
    *Cough that's new or worsening (continuous.more than usual)
    *Barking cough, making a whistle noise when breathing (croup) 
    *Shortness of breath (out of breath, unable to breathe deeply) 
    *Sore throat
    *Difficulty swallowing
    *Runny nose, sneezing, or nasal congestion (not related to seasonal allergies or  other known causes or conditions) 
    *Lost sense of smell or taste
    *Pink Eye (conjunctivitis) 
    *Headache that's unusual or long lasting
    *Digestive Issues (nausea/vomiting, diarrhea, stomach pain) 
    *Muscle aches 
    *Extreme tiredness that is unusual (fatigue, lack of energy) 
    *Falling Down often
    *For young children and infants: sluggishness or lack of appetite


    The answer to all questions must be “No”in order to participate in any and all activity (on-ice or off-ice).

    For the remaining questions, close physical contact means being less than 2 metres away in the same room, workspace, or area for over 15 minutes or living in the same home.

    *In the last 14 days, have you been in close physical contact with someone who tested positive for COVID-19?

    *In the last 14 days, have you been in close physical contact with a person who either:

    *Is currently sick with a new cough, fever, or difficulty breathing;

    *Or returned from outside of Canada in the last 2 weeks?(This does not include essential workers who cross the Canada-US border regularly.)

    *Have you travelled outside of Canada in the last 14 days?(This does not include essential workers who cross the Canada-US border regularly.)

    If an individual has answered “Yes” to  any of  these questions, they are not permitted  to participate in any on-ice or  off-ice activities.
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Printed from on Wednesday, January 27, 2021 at 9:24 PM