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Group Training Questionnaire
Please fill out and submit this form.
11
Questions
START
1
Please Choose Your Attachment
*
This field is required.
Choose your club or as an unattached athlete please choose unattached.
EDMONTON COLUMBIANS
UNATTACHED
UNATTACHED
EDMONTON COLUMBIANS
UNATTACHED
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2
Have you been on a trip outside of Canada in the past 14 days?
*
This field is required.
YES
NO
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3
You are not cleared to practice today.
If you answered YES to any of the screening questions you should complete the AHS Self Assessment and self-isolate for 14 days before returning to practice.
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4
Are you experiencing any of the following symptoms:
*
This field is required.
Fever, Chills, Cough, Barking Cough/Croup, Shortness of Breath, Sore Throat, Difficulty Swallowing, or Runny Nose
YES
NO
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5
You are not cleared to practice today.
If you answered YES to any of the screening questions you should complete the AHS Self Assessment and self-isolate for 14 days before returning to practice.
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6
Have you knowingly been in contact with or cared for someone with COVID-19 in the past 14 days?
*
This field is required.
YES
NO
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7
You are not cleared to practice today.
If you answered YES to any of the screening questions you should complete the AHS Self Assessment and self-isolate for 14 days before returning to practice.
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8
Have you stayed at home in the past two weeks due to being sick?
*
This field is required.
YES
NO
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9
You are not cleared to practice today.
If you answered YES to any of the screening questions you should complete the AHS Self Assessment and self-isolate for 14 days before returning to practice.
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10
Non-Essential Self-Travel Report
*
This field is required.
Have you travelled outside of Alberta in the past 7 days?
YES
NO
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11
Self-Report of Non-Essential Travel
Please indicate: Date or dates or travel, locations, and duration
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12
Athlete's Name
*
This field is required.
I declare that all the above information is correct and reported honestly
First Name
Last Name
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13
Parent's Name (for athlete's under 18)
I declare that all the above information is correct and reported honestly
First Name
Last Name
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14
Your Email
*
This field is required.
Parental Email for athlete's under 18
example@example.com
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15
Date of Form Signed
*
This field is required.
This is fill automatically - no need to choose the date.
Date
Year
Month
Day
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16
By digitally signing below I declare that all the above information is correct and reported honestly:
*
This field is required.
Parental Signature required for athlete's under 18.
Clear
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