z2021-2022 COVID Screening Form - Holiday Santa Skate (Newcastle Village Minor Hockey Association)

z2021-2022 COVID Screening Form - Holiday Santa Skate

2021-2022 COVID 19 SCREENING FORM - HOLIDAY SANTA SKATE

SATURDAY DECEMBER 18th - 5:00pm-6:00pm at NEWCASTLE MEMORIAL ARENA

THIS MUST BE COMPLETED PRIOR TO ENTERING THE ARENA.

Arena and desk attendants to confirm that this form has been completed for all skaters prior to arena entry.

Let's all do our part and keep our community safe for everyone!

Name of Player: ^*

Required

Please enter name of player or member here

Names of Additional Skaters:^*

Required

Include all spectators and skaters

Contact number:^*

Required

Please enter a phone number for contact tracing purposes.

I confirm that I am not experiencing any of the following symptoms: Fever, cough, shortness of breath, loss of taste, sore throat, nausea.

I confirm^*

I confirm that I have not travelled outside of Canada in the past 14 days and/or have been told to quarantine (per the federal quarantine requirements)

I confirm^*

I confirm that I have completed this self-assessment for both my player and all other associated skaters and spectators.

I confirm^*

I confirm that the assessment results indicate that I do not seem to have symptoms and I have not been directed to quarantine or take a COVID test.

I confirm^*

I confirm that I have answered the above questions honestly and to the best of my ability

I confirm^*

I understand and acknowledge that disciplinary actions will result if I am found not following public health guidelines or have provided false information to NVMHA

I confirm^*

z2021-2022 COVID Screening Form - Holiday Santa Skate (Newcastle Village Minor Hockey Association)

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