COVID-19 Screening Form
Please answer all questions truthfully for the health and safety of our Canoe Club.
Sign in to Google to save your progress. Learn more
Email *
What is today's date? *
What is the participant's full name? *
Which program is the participant registered in? *
Are you currently experiencing any of these issues? Call 911 if you are. Severe difficulty breathing (struggling for each breath, can only speak in single words), severe chest pain (constant tightness or crushing sensation), feeling confused or unsure of where you are, or losing consciousness *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pickering Rouge Canoe Club. Report Abuse