Covid-19 Pre-Screening - BHOH

Whose House Is This? Our House!

Main menu:

Home
What We Offer
- Warriors Hockey Academy
- Warriors Ringette Academy
- Warriors Skating Academy
  - Learn to Skate
- Jr Warriors Academy
  - Coed 3 on 3
  - Female 3 on 3
- Adult Warriors Academy
- Camps & Clinics
- Private Lessons
- Team Development
- High Performance
Registrations Store
Calendar of Events
- Programs
- Camps & Clinics
About Us
- Mission Statement
- History
- Staff/Instructors
Contact Us
- By Email & Phone
- Covid-19 Pre-Screening
- Training Locations
X-Tra's/Links

Covid-19 Pre-Screening

This form must be completed 24 hrs prior to the Program being attended! Failure to do so will deny attendance of the Program!

Contact Person

Please fill in the following information if you are the participant in an Adult Program or the guardian/parent of the child participant.

First Name*

Last Name*

Phone*

Email*

Repeat Email*

Program Date*

Program Start Time*

Failure to complete the following sections will result in denial to participate and/or watch your child participate.

Child Participant Info (Required for ALL Tot, Teen and Youth Programs)

First Name

Last Name

Birthdate

Child Participant Assistant Info (Parent & Tot Programs ONLY) Complete even if same as person completing this form!

First Name

Last Name

Relationship to Participant

Parent/Guardian Attendee (person staying as spectator) Complete even if same as person completing this form!

First Name

Last Name

Phone

Definitions

- particiapnt means child or adult registered in a program;
- assistant means person engaging with child participant in on-ice program;
- attendee means parent or guardian (one only) attending as a spectator in the approved viewing areas;
- unprotected means close contact (face-to-face contact within 2 meters/6 feet) without masks or other appropriate Personal Protective Equipment (PPE); and
- ill means someone with Covid-19 symptoms as listed below in the questionnaire.

Questionnaire

Does the participant, assistant or attendee have any of the following symptoms:

Fever?*

No
Yes

Chills?*

No
Yes

Headache?*

No
Yes

Fatigue?*

No
Yes

Diarrhea?*

no
Yes

New Cough or worsening of chronic cough?*

No
Yes

Shortness of breath or difficulty breathing?*

No
Yes

Sore throat or painful swallowing?*

No
Yes

Loss of sense of smell or taste?*

No
Yes

Muscle aches?*

No
Yes

Nausea and Vomiting?*

No
Yes

Loss of appetite?*

No
Yes

Runny Nose/Nasal Congestion?*

No
Yes

Has the participant, assistant or attendee travelled outside of Canada in the past 14 days?*

No
Yes

Has the participant, assistant or attendee had close unprotected contact with someone who has travelled outside of Canada in the past 14 days?*

No
Yes

Has the participant, assistant or attendee been directed by Public Health to slef-isolate in the past 14 days?*

No
Yes

Has anyone in the participants, assistants or attendees household been in unprotected contact with someone who is ill or who is being investigated for or confirmed to have Covid-19?*

No
Yes

Check word:

Advertise Here With Us!

Contact by email for info!