Snipe Daily Health Questionnaire

Where is your session being held?

SNIPE Academy Cambridge (389 Clyde Rd.) Cambridge Sports Park (1001 Franklin Blvd.) Other
Cambridge Sports Park requires all participants to complete their own sports waiver. This only needs to be completed 1 time. Have you already completed the Buckingham Sports Waiver for your child?

Yes No
Please use the QR Code or the link below to complete the Buckingham Sports Waiver.

https://form.jotform.com/210555941473053

2. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If your child is fully vaccinated (it has been 14 or more days since his/her final dose), select “No.” If the person got a COVID-19 vaccine in the last 48 hours and is experiencing a mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.” *

Yes No
2. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If you are fully vaccinated (it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series), select “No.” If the person got a COVID-19 vaccine in the last 48 hours and is experiencing a mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.” *

Yes No

3. Has your child traveled outside of Canada in the last 14 days? (If exempt from federal quarantine requirements (for example, you are fully vaccinated and have met the specific conditions, or an essential worker who crosses the Canada-US border regularly for work), select “No.”) *

Yes No
3. Have you traveled outside of Canada in the last 14 days? (If exempt from federal quarantine requirements (for example, you are fully vaccinated and have met the specific conditions, or an essential worker who crosses the Canada-US border regularly for work), select “No.”) *

Yes No

4. In the last 14 days, has your child been identified as a “close contact” of someone who currently has COVID-19? If your child is fully vaccinated (it has been 14 or more days since his/her final dose) and has not been told to self-isolate by public health, select “No.”) *

Yes No
4. In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?If you are fully vaccinated (it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series) and have not been told to self-isolate by public health, select “No.”

Yes No

Date *

Month Day Year
Date
By providing answers to this questionnaire and signing below, you confirm that all answers are accurate. *

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