Amazing Adventures - Daily Screening Questionnaire - July 2020
Dear parent or guardian, so that we can assess our ability to care for your child today, please fill out this questionnaire to determine if your child can attend programming today.
Name of Athlete / Parent / Person entering the facility *
Date *
Do you or your child attending today, have any of the following symptoms? *
Shortness of breath or difficulty breathing
Sore throat
Runny nose or congestion
Feeling unwell
Nausea, vomiting, or diarrhea
Muscle aches
New loss of sense of taste or smell
Have you, or anyone in your household, traveled outside of Saskatchewan in the past 14 days? *
Have you, or anyone in your household, in the past 14 days travelled to a community in Saskatchewan with a COVID-19 outbreak? *
Have you or anyone in your household been in direct UNPROTECTED contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? *
Have you, or anyone else in your household traveled internationally and/or been instructed to self-isolate for any other reason? *
If you answered "yes" to questions #1, #4 or #5, please DO NOT enter at this time.

If you have recently developed any of these symptoms, please call 811 or visit:
to do a self-assessment to see if you require testing.

Be sure to practise good hand hygiene (use hand sanitizer or wash hands with soap and water for at least 20 seconds before entering and leaving the facility.

Our goal is to minimize the risk of illness to you, your children and family and our staff. We thank you for your cooperation and understanding.
Signature *
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