ABRA Program COVID-19 Health Assessment :
Name Of Participant / Child
Name Of Second Participant / Child (If Applicable)
Ball Hockey (5-7, 8-12)
Beginners Basics Knitting (16+)
Core Pilates (16+)
Fun-ctional Fitness (18+)
Junior Tennis (4-6, 7-12)
Karate (4-7, 8-12)
Kids Uke Night (7-12)
Learn to Play Tennis (16+)
Multi-Sport (3-5, 6-8)
Prince Basketball (5-7, 7-9, 9-12)
Salsa Date Night (18+)
Thanksgiving Cornucopia Workshop (16+)
Twinkle Toes (3-4, 5-6)
Uke Night (13+)
Weights Class (16+)
Wiggly Worms Dance (3-4, 5-6)
Young Rembrandts (3.5-5, 6-12)
State / Province
Have you, or anyone in your household, traveled outside of Canada in the past 14 days?
Have you, or anyone in your household, tested positive for COVID-19 in the past 14 days?
Are any members of your household currently experiencing any of the following symptoms: fever above 38 degrees Celsius, cough, shortness of breath/difficulty breathing, sore throat, runny nose?
Do you understand and consent to the terms outlined in the COVID-19 lake use information sheet (https://bit.ly/2XZiIwO)?
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