U7 (IP) COVID SCREENING (Warkworth Minor Hockey)

Player/Spectator Information

Player/Spectator Name^*

Required

A separate form must be completed for EACH person entering the arena

Date and Start Time of Activity^*

Required

Contact Phone Number^*

Required

Example: ###-###-####

Contact Email Address^*

Required

Use email who will be dropping off player and providing confirmation of completed form. A copy of the form will be sent to this address, if you do not receive a copy neither did we!

ARE YOU CURRENTLY EXPIERENCING1 ANY OF THESE SYMPTOMS?

The answer to all questions must be “No” in order to participate in each on-ice activity. If you have answered 'YES' to any of the following questions it is recommended that you self isolate and consider getting tested for COVID 19.

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 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?^*

YesNo

Required

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.)^*

YesNo

Required

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

YesNo

Required

U7 (IP) COVID SCREENING (Warkworth Minor Hockey)

OMHA Digital Network

Player/Spectator Information

ARE YOU CURRENTLY EXPIERENCING1 ANY OF THESE SYMPTOMS?

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 Living in the same home

Get Mobile!

Contact Us