Black Gold 15UAA 2021 Evaluations COVID Tracing
Based on how the individual (or guardian) answers the questions, they MAY NOT be allowed to participate in Baseball Activity as per AHS guidelines. Children/youth must have a parent complete this screening tool. Coaches/Managers must also complete. PLEASE COMPLETE THE FORM WITHIN 2 HOURS PRIOR TO ATTENDING EVENT/PRACTICE/GAME.
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Email *
Identify the team you are evaluating for
Name of participant (First Name Last Name)
Date of event/practice/game *
MM
/
DD
/
YYYY
Time of event/practice/game *
Time
:
Are you (or minor participant) experiencing any of the following symptoms: fever, shortness of breath, cough, sore throat, runny nose, nasal congestion, chills, painful swallowing, loss of taste or smell, nausea, headache, muscle ache, conjunctivitis (pink eye) or loss of appetite? *
Required
Have you (or minor) travelled outside of Canada in the past 14 days? *
Required
Have you (or minor) been in close contact with someone who is ill, being investigated for, or a confirmed COVID-19 case in the past 14 days? *
Required
Name of parent or legal guardian, if required (First name last name) *
Submit
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