VISITING TEAM - Covid Screening form (Millbrook Minor Hockey)

Print VISITING TEAM - Covid Screening form
You will receive a confirmation email when you complete this form. Please show the confirmation email at the door before entering the arena
Your Information
Please provide name for who the document is for (i.e. if player documents provide players name and provide parent/guardian info in the extra box provided)
  1. RadDatePicker
    RadDatePicker
    Open the calendar popup.
  2. You will receive a confirmation of your submission to this address to show at the rink
  3. Example: ###-###-####
Do any of the following apply to you?
  1. The answer to all questions must be “No” in order to participate in any and all activity. If the answer is "yes" to any of the following symptoms please stay home.

    Are you currently experiencing any of these symptoms?

    1) Fever and/or chills
    2) Cough or barking cough(croup)
    3) shortness of breath,
    4) Decrease or loss of taste or smell 
    5) Muscle aches/joint pain 
    6)Extreme tiredness (unusual, fatigue, lack of energy)

Assessment Continued
The answer to all questions must be “No” in order to participate in any and all activity. If the answer is "yes" to any of the following symptoms please stay home.
  1. If you have since tested negative on a lab-based PCR test, select "No."
Human Validation
Printed from millbrookhockey.com on Saturday, December 4, 2021 at 6:11 AM