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
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?
Port Perry Skating Club
Port Perry Synchronized Skating (beginner/elementary)
Port Perry Synchronized Skating (Adult)
Date of Session
Time of Session
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