Athlete Daily Screening
This form must be completed prior to every class you are attending. DO NOT ATTEND CLASS if you are sick, or answer YES to any of the questions below.

The information recorded on this checklist is collected under the Personal Information and Privacy Act (PIPA) and will be used only for the purpose of providing Alberta Health the information in the event of a contagion incident. This will be retained for a period of 30 days and then destroyed.
Email address *
Athlete Name *
Emergency Contact Name *
This information may not be the same emergency contact we have on file. Please provide contact information to supply to Alberta Health Services for contact tracing purposes in the event there are any reported COVID-19 illnesses that may affect your athlete or others they have been in contact with.
Emergency Contact Telephone *
This information may not be the same emergency contact we have on file. Please provide contact information to supply to Alberta Health Services for contact tracing purposes in the event there are any reported COVID-19 illnesses that may affect your athlete or others they have been in contact with.
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