COVID - Group 3 (Ancaster Minor Hockey)

COVID - Group 3
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

Participant Information

Please enter participant's info here.

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***

TERMS AND CONDITIONS

Ar
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

TERMS AND CONDITIONS

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

1
.  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)

TERMS AND CONDITIONS

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


1. Are you currently experiencing any of these symptoms?

*Do you have a Fever? (Feeling hot to touch, temperature of 37.8C or higher) 
*Chills
*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


TERMS AND CONDITIONS:

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.)
TERMS AND CONDITIONS

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.