CanSkate Sessions Attendance and Health Screening Form
Please provide the following information prior to each on-ice session attended.
Skater Last Name *
Skater First Name *
Date of the Attended Session
MM
/
DD
/
YYYY
Spectator Name
Spectator Cell Phone Number
In the last 14 days, have you or a member of your household traveled outside Atlantic Canada? *
If yes, the participant is not permitted to attend HSC events for 14 days from the date of the return from out of Atlantic Canada.
In the last 14 days, have you had close contact (within 2 meters / 6 feet) with someone confirmed to have COVID-19? *
If yes, the participant is not permitted to HSC events for 14 days from the date the participant last had contact with the COVID-19 positive individual.
Required
In the past 48 hours have you had, or are you currently experiencing, any of these symptoms? *
If yes, the participant is not permitted to attend HSC events until symptoms have disappeared or a negative COVID-19 test is provided.
Yes
No
A fever (i.e. chills/sweats) OR Cough (new or worsening)
Two or more of the following symptoms (new or worsening) - Sore throat, Runny nose/nasal congestion, Headache, Shortness of Breath
Do you feel unwell today? *
If yes, the participant is not permitted to attend HSC session.
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy