Players Name: *

Parent Full Name: *

Have you ever tested positive for COVID-19     
 Have you been tested for COVID-19 and are waiting for results?     
 Do you have a fever (+38C / 100.4F) or above-normal temperature?     
 Do you have a dry cough?     
 Do you have a sore throat?     
 Do you have a runny nose?     
 Have you experienced shortness of breath or had trouble breathing?     
 Have you recently lost or had a reduction in your sense of smell?     
 Have you been in contac with someone who has tested postitive for COVID-19?     
 Do you have any conditions in your health history that may result in a compromised immune system?     
 Have you traveled outside of Canada by air, bus, train, or cruise ship within the past 14 day?     

Date Submitted: