All players must complete this questionnaire at least 2 hours prior to their skate.

Player - First Name *

First Name - Title Case, e.g. Connor

Player - Last Name *

Last Name - Title Case, e.g. McDavid

WEEK 1 - Select applicable skate session *

U13 Peewee August 17-21 Kenilworth

U15 Bantam August 17-21 Kenilworth

U16 Midget August 17-21 Kenilworth

U18 Midget August 17-21 Kenilworth

Parent Name *

First Last Name

Phone Number *

Smartphone

Email *

Contact Email Address

Is the player experiencing any symptoms? *

Yes

Has the player or any family member attending the skate had close unprotected contact (face-to-face contact within 2 metres/6 feet) with someone who is ill with a cough/fever? *

Yes

Has the player or anyone in your household been in close unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? *

Yes

If you have checked any boxes indicating symptoms or answered YES to any of these above questions, do not participate in the ice session. Go home and please use the Alberta Health Services Online Assessment Tool to determine if testing is required.

Thank you for completing this form.

South Side Athletic Club

Elite AAA/AA | U13 | U15 | U16 | U17 | U18

SSAC COVID Questionnaire | Aug 17-21

SSAC COVID Pre-Skate Health Questionnaire