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 www.kwsc.org/news/covid-19
Spectator first and last name *
What is the date? *
MM
/
DD
/
YYYY
What time is your session? (Start time) *
Time
:
Do you have ANY of the following symptoms? (PLEASE NOTE: if you select any of the following symptoms, please stay home and isolate) *
Required
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* *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms