SPECTATORS - KWSC - Mandatory Health/Attendance Questionnaire
A daily health screening is MANDATORY for all Skaters, Coaches, Music Players, Program Assistants, Volunteers, and Spectators/Parents/Guardians who wish to attend KWSC activities held at any KWSC rinks in the Region.
SPECTATORS, please complete this form on the day of your skaters session - questionnaires must be filled out and submitted BEFORE coming to the facility. Your skater will be screened by their coach when they arrive at the rink.
*Spectators are only allowed for skaters that are 17 years of age and YOUNGER. Only ONE spectator is permitted per skater*
For all of KWSC's Covid-19 Updates, visit
Spectator first and last name
What is the date?
What time is your session? (Start time)
Do you have ANY of the following symptoms? (PLEASE NOTE: if you select any of the following symptoms, please stay home and isolate)
Fever (feeling hot to the touch, a temperature of 37.8C or higher)
Cough (New or worsening)
Shortness of breath
Runny, stuffy, or congested nose (not related to known causes such as allergies)
Sore throat, difficulty swallowing
NONE OF THE ABOVE
Have you traveled outside of Canada, or had close contact with anyone who has traveled outside of Canada in the past 14 days?
In the past 14 days, have you come into close contact with someone with COVID-19 symptoms, or a suspected or confirmed case of COVID-19?
I will abide by the rules and regulations, policies, and procedures of Kitchener Waterloo Skating Club and City of Kitchener. I will use the facility in a manner consistent with its intended use and application. I have provided accurate information on my health status as of the time of this submission. If there is a change in my health status between now and the start of the activity, I will not enter the facility. *Please note that if you do not agree with this statement, you are not permitted to enter the facility*
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