COVID-19 Arnprior Ringette Player Screening
Please Complete the below questionnaire prior to your Squads ice-time on the same day.

REMINDER- THIS FORM IS ONLY VALID IF COMPLETED ON THE DAY OF YOUR ACTIVITY.

A new form must be completed prior to each entrance of the facility.
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Email *
Participants Name *
Parent/Guardian Name (if accompanying minor)
Which Squad are you? *
Location (which Ice Surface) *
Date of Ice Session *
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Time of Ice Session *
Time
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Do you currently have any COVID-19 related symptoms? (fever, chills, cough, difficulty breathing, sore throat, runny nose, loss of taste/smell, diarrhea, nausea, vomiting, abdominal pain or nasal congestion) *
In the last 14 days, have you traveled outside of Canada or have you close physical contact with a person who has returned from travel outside of Canada? *
By agreeing, I acknowledge that all information provided above is accurate and I have agreed to follow the policies and procedures put in place by the Arnprior McNab Ringette Assosication and Nick Smith Center upon entering the building. *
If you answered YES to any of the screening questions above, go home & self-isolate right away. Visit www.rcdhu.com for more information as you  may be eligible for COVID-19 test.
If feeling unwell, contact your health care provider or call Telehealth Ontario at 1-866-797-0000 to speak to a registered nurse.
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