Elite Camps Training Centre COVID-19 Screening

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Please fill out this form prior to coming to your program.

What is (are) your athlete's FIRST name(s)? *

What is (are) your athlete's LAST name(s)? *

What is the account holder's email address on file? *

What is your phone number? *

When is your athlete's next program date *

YYYY

Does anyone in your family have any of the following new or worsening symptoms or signs? *

New or worsening cough

Shortness of breath

Sore throat

Runny nose, sneezing, or nasal congestion (in absence of underlying reasons for symptoms such as seasonal allergies and post nasal drip)?

Hoarse voice

Difficulty swallowing

New smell or taste disorder(s)

Nausea/vomiting, diarrhea, abdominal pain

Unexplained fatigue/malaise

Headache

None of the above

Required

Has anyone in your family traveled outside of Canada or had close contact with anyone that has traveled outside of Canada in the past 14 days? *

Yes

Does anyone in your family have a fever? *

Yes

Has anyone in your family had close contact with anyone with respiratory illness or a confirmed or probable case of COVID-19? *

Yes

If so, was the member of your family wearing the required and/or recommended PPE according to the type of duties you were performing (e.g., goggles, gloves, mask and gown or N95 with aerosol generating medical procedures (AGMPs)) when you had close contact with a suspected or confirmed case of COVID-19? *

Yes

Not applicable, haven't been in close contact with anyone with a respiratory illness or a confirmed or probable case of COVID-19

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