BC Covid-19 Daily Screening (Flip City Gymnastics Club)
Anyone entering our facility must do the Daily Screening form.
Anyone entering our facility MUST fill this form out DAILY.
A one time medical form will be required to be filed out for all athletes to disclose any medical concerns, Flip City should be aware of, if you or your child has any pre-existing conditions.
Please see these guidelines from Gymnastics BC:
o If an individual experiences seasonal allergies (or other cold symptoms), they should get a doctor’s note explaining their symptoms before entering the gym.
o Immuno-compromised (high-risk) individuals should consult a medical practitioner before returning to the gym.
Choose which group you are part of:
WAG - Including Dev.
REC - Active start, Acro etc.
Athlete/Guest or Coach Name
Do you have any of the symptoms below? Please check off if the participant is experiencing any of the following symptoms. (*Note: fatigue and muscle aches may be expected as athletes return to sport. All participants, parents/guardians of minors, and club personnel must determine the difference between this and symptoms of illness)
• Fever (greater than 38.0°C) and/or chills
• Sore throat and/or painful swallowing
• Stuffy and/or runny nose
• Loss of appetite
• Shortness of breath
• Loss of sense of smell
• Muscle aches
Any health concerns that need to be addressed?
Have you, or has anyone in your household been in contact in the last 14 days with someone who is being investigated or who has a confirmed case of COVID-19?
Are you currently being investigated as a suspect case of COVID-19?
Have you tested positive for COVID-19 within the last 10 days?
Emergency Contact NAME for the day (MUST NAME A CONTACT THAT CAN PICK UP IMMEDIATELY IF NECESSARY)
Emergency Contact - PHONE NUMBER (MUST FILL OUT)
(Parent Name/Guest or coach PLEASE) that has filled out this form. I agree that all the information is true to date and allow my child or myself to participate in all activities today. If my child or myself is ill or requires to be picked up (sudden illness, injury etc.) then I will make arrangements immediately to have them picked up. I understand, Flip City Gymnastics Club has the right to refuse my child from training if they suspect any sign of illness or I have not consented to this form. I understand that I will follow, and my child will follow all the Return to Play requirements and guidelines set forward by Flip City Gymnastics Club.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service