U9 COVID Screening Form (Manvers Minor Hockey)

Print U9 COVID Screening Form
This screening tool must be completed by each participant prior to participation in each on-ice or off-ice activity.
Your Information
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  3. Example: [email protected] Your submission will be sent to this address.
Vaccination Status & COVID-19 Screening
  1. Are you currently experiencing any of these symptoms? 

    • Do you have a fever? (Feeling hot to the touch, a temperature of 37.8C or higher) or Chills?

    • Cough that’s new or worsening? (continuous, more than usual) or a barking cough?, making a whistling noise when breathing? (croup)

    • Shortness of breath? (out of breath, unable to breathe deeply) 

    • Lost sense of taste or smell? 

    • Nausea, vomiting or diarrhea 

  2. For the remaining questions, close physical contact means: 

    Being less than 2 metres away in the same room, workspace, or area for over 15 minutes living in the same home. 


    1.  
    In the last 10 days, have you been in close physical contact with someone who tested positive for COVID-19?

    2.  In the last 10 days, have you been in close physical contact with a person who either: Is currently sick with a new cough, fever, or difficulty breathing; OR Returned from outside of Canada in the last 2 weeks? 

    3.  
    Have you travelled outside of Canada in the last 14 days?

Human Validation
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Printed from manvershockey.com on Friday, January 21, 2022 at 6:33 PM