Group Training Questionnaire

1

Please Choose Your Attachment* This field is required.Choose your club or as an unattached athlete please choose unattached.

2

Have you been on a trip outside of Canada in the past 14 days?* This field is required.

YESNO

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.

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

YESNO

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.

6

Have you knowingly been in contact with or cared for someone with COVID-19 in the past 14 days?* This field is required.

YESNO

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.

8

Have you stayed at home in the past two weeks due to being sick?* This field is required.

YESNO

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.

10

Non-Essential Self-Travel Report* This field is required.Have you travelled outside of Alberta in the past 7 days?

YESNO

11

Self-Report of Non-Essential Travel Please indicate: Date or dates or travel, locations, and duration

12

Athlete's Name* This field is required.I declare that all the above information is correct and reported honestly

First Name

Last Name

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

14

Your Email* This field is required.Parental Email for athlete's under 18

example@example.com

15

Date of Form Signed* This field is required.This is fill automatically - no need to choose the date.

Date

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