SWEMBA COVID 19 QUESTIONNAIRE AND ATTESTATION
Before commencing any baseball activities, the association is responsible for ensuring all individuals complete the attestation below. All individuals participating in any baseball activities must fill out and submit this form.
Name of Participant (player) *
Participant Date of Birth
MM
/
DD
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YYYY
Division *
Are you exhibiting the following COVID Symptoms: - Fever - Shortness of breath - Chills - Sore throat - Cough - Difficulty swallowing - Barking cough/croup - Runny nose *
Have you been in close contact with or cared for someone with COVID-19 in the past 14 days. *
Having you been on a trip outside of Canada in the past 14 days. *
Have you stayed at home in the past two weeks due to being sick. *
IF it is a NO to all the above, you are free to participate in practice (assessments). If yes to any of the above, you need to isolate for 14 days before returning to train.
Travel Declaration
Only Complete if you have travelled out side the province.
Clear selection
If you answered yes above, please provide the (1) Location of Travel and (2) The Duration of Trip
Name of Parent (if participant is a minor)
By checking the box below, you verify that the above information is true and acts as your signature. *
Required
Submit
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