GMB COVID-19 Daily Assessment Tool

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U13 Boys Club - Spring 2021

Athlete's First and Last name: *

Have you traveled outside the province within the last 14 days? Travel includes passing through an airport. *

Yes

Have you provided care or had close contact with a person with COVID-19 (probably or confirmed) within the last 14 days? *

Yes

Do you have any of the following symptoms (new or worsening)? *

Fever (or signs such as chills, sweats, muscle aches, or feeling lightheaded)

Cough

Headache

Sore Throat

Small red or purple spots on your hands and/or feet

Painful swallowing

Runny Nose

Unexplained loss of appetite

Diarrhea

Loss of sense of smell or taste

NONE OF THE ABOVE

If you answered YES to any of the previous questions DO NOT PROCEED TO FACILITY. Remain at home and self-isolate. Visit gov.nl.ca/COVID-19 or call 811. If you responded NO to all questions, you may proceed to facility. *

I understand.

Liability Waiver - check each box to acknowledge that you have read and understand each statement. *

I acknowledge the contagious nature of COVID-19 and agree to adhere to distancing guidelines recommended by public health officials

I acknowledge COVID-19 exposure/infection may result from the actions of myself, others and their families

I agree to follow all safety precautions outlined by Gander Minor Basketball, and governing sport bodies

I acknowledge Gander Minor Basketball cannot guarantee that I will not become infected with COVID-19

Required

Today's Date *

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