PPSC COVID-19 PreScreening
This questionnaire must be completed by each individual prior to participation in each on-ice club/skating school activity.

The answer to all questions must be “No” in order to participate in each on-ice activity.

*Please note: This Health Screening questionnaire has been developed based on the current Ontario Ministry of
Health Self-Assessment Tool
Contact information:
Skater/Volunteer/Parent/Coach (First and Last Name) *
Parent Email or Phone Number *
Parent/Guardian first and last name (if skater is under 18)
Which Organisation are you skating for today? *
Date of Session *
MM
/
DD
/
YYYY
Time of Session *
Time
:
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