YRFA Fall 2021 Season Screening Form
All players, coaches and volunteers must complete the screening form prior to weekly participation. Thank you in advance for completing.
Email *
First Name *
Last Name *
Select discipline *
Age Group (for your player & you) *
**Individuals aged 18 or older, please answer this section** Are you currently experiencing one or more of the symptoms below that are new or worsening? (Not related to chronic or other known causes/conditions)
**Individuals who are under 18, please answer this section** Do you have one or more of the following symptoms?
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *
In the last 14 days, have you been identified as a "close contact" of someone who currently has COVID-19? *
In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? *
In the last 14 days, have you travelled outside of Canada and been told to quarantine? (per federal guidelines under the Quarantine Act) *
In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit? *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy