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

Player - First Name *

First Name - Upper & lower Title Case, e.g. Connor

Player - Last Name *

Last Name - Upper & lower Title Case, e.g. McDavid

AFTERNOON WEEK - Select applicable skate session *

U13 Peewee August 10-14 Callingwood

U15 Bantam August 10-14 Callingwood

U16 Midget August 10-14 Callingwood

U18 Midget August 10-14 Callingwood

Parent Name *

First Last Name

Phone Number *

Smartphone

Email *

Contact Email Address

Has the player or any family member attending the skate had close unprotected contact (face-to-face contact within 2 metres/6 feet) with 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

SSAC COVID Pre-Skate Health Questionnaire