2020-21 COVID Health Screen (Caledonia Old Timers Hockey)
Print
2020-21 COVID Health Screen
Prior to a Player sparing for our league, they must complete the following Health Screen
Player Information
First Name
*
Last Name
*
Cell Phone Number
*
Example: ###-###-####
Email Address
*
Example:
[email protected]
Your submission will be sent to this address.
Hockey & Game Information
Game Date
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
February 2021
>
<<
February 2021
S
M
T
W
T
F
S
6
31
1
2
3
4
5
6
7
7
8
9
10
11
12
13
8
14
15
16
17
18
19
20
9
21
22
23
24
25
26
27
10
28
1
2
3
4
5
6
11
7
8
9
10
11
12
13
Game Time/Ice Pad
*
Select One...
9:30pm - Clark Pad
10:00pm - Almas Pad
Position
*
Select One...
Goalie
Referee
Timekeeper
Health Question 1: Are you currently experiencing any of these symptoms?
Please answer all questions. The answer to all questions must be “No” in order to participate in any and all activity.
Do you have a fever? (Feeling hot to the touch, a temperature of 37.8C or higher)
*
Yes
No
Do you have the Chills?
*
Yes
No
Do you have a cough that’s new or worsening (continuous, more than usual)
*
Yes
No
Do you have a Barking cough, making a whistling noise when breathing (croup)
*
Yes
No
Do you have Shortness of breath (out of breath, unable to breathe deeply)
*
Yes
No
Do you have a sore throat or difficulty swallowing
*
Yes
No
Do you have a runny nose, sneezing or nasal congestion (not related to seasonal allergies or other known causes or conditions)
*
Yes
No
Do you have a lost sense of taste or smell
*
Yes
No
Do you have pink eye (conjunctivitis)
*
Yes
No
Do you have a headache that’s unusual or long lasting
*
Yes
No
Do you have digestive issues (nausea/vomiting, diarrhea, stomach pain)
*
Yes
No
Do you have muscle aches
*
Yes
No
Do you have extreme tiredness that is unusual (fatigue, lack of energy)
*
Yes
No
Are you falling down often
*
Yes
No
Health Background Questions 2 thru 4
Please answer all questions. The answer to all questions must be “No” in order to participate in any and all activity
2. In the last 14 days, have you been in close physical contact with someone who tested positive for COVID-19?
*
Yes
No
3. In the last 14 days, have you been in close physical contact with a person who either: Is currently sick with a new cough, fever, or difficulty breathing; OR Returned from outside of Canada in the last 2 weeks?
*
Yes
No
(This does not include essential workers who cross the Canada-US border regularly.)
4. Have you travelled outside of Canada in the last 14 days?
*
Yes
No
(This does not include essential workers who cross the Canada-US border regularly.)
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again
League Sites
Caledonia Oldtimers
View All
Our Sponsors
Manage Subscriptions
Signup to receive
email
or
text messages
for the teams you want to follow.
Login
Sitemap
Help
Contact
Search
Rss
Thu Feb 25, 2021
Recent Results
Caledonia Old Timers Hockey
Home
About Us
Mission & Vision
Executive & Staff
Oldtimer Team Reps
Contact Us
Games Centre
Schedule & Results
League Calendar
League Standings
Registration
Registration Information 2020-21
Refund Policy 2020-21
2020-21 Registration - Goalies
2020-21 Registration - Full Time Skaters Returning from 2019-20 Season
2020-21 Registration - Spare and Full Time Skaters Returning from 2019-20 Season
2020-21 Registration - New Skaters & Past Members from 2018-19 & Prior Seasons
2020-21 Registration - Wait List
Association Documents
Classifieds
COVID Information and Policies
2020-21 COVID Health Screen
Links
2019-20 Team Photos
My Calendar
Share
Feedback
You Are Here:
Organization Home
» 2020-21 COVID Health Screen
Printed from caledoniaoldtimershockey.com on Thursday, February 25, 2021 at 1:43 PM
Social Bookmarks
(What's This?)