COVID-19 Screening Waiver

COVID-19 SCREENING WAIVER FORM

All participants in Lights Out Skating Academy training programs must complete the Covid-19 Screening Waiver form below.

Parent Guardian Information

enter the parent/guardian information

Player Information

enter the player information

Covid-19 Screening

please complete the Covid19 screening questions below.

Are you unusually experiencing one or more of the following symptoms that are not associated with any pre-existing condition(s) to which you are aware of? (see symptom table below)

Yes

Most Common Symptoms
• Fever • Dry Cough • Tiredness
Less Common Symptoms
• Aches and Pains • Sore Throat • Diarrhea • Conjunctivitis • Headache • Loss of taste or smell • A rash on skin, or discolouration of fingers or toes
Serious Symptoms
• Difficulty breathing or shortness of breath • Chest pain or pressure • Loss of speech or movement

Have you been in close contact with a confirmed or probable COVID-19 case?

Yes

Have you been in close contact with a person who is in self-isolation or quarantined?

Yes

Have you had close contact with a person who has been outside Canada in the last 14 days?

Yes

If you answered NO to all questions, you are cleared to enter.
If you answered YES to any of the questions, you will not be granted permission to enter. Please call your local heath unit or health care provider.

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COVID-19 Screening Waiver

COVID-19 SCREENING WAIVER FORM

Parent Guardian Information

Player Information

Covid-19 Screening