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Home
Rules
Directors
Membership
Calendar
Current Events
Results & Ratings
Meeting Minutes
Checkout
Cart
COVID-19 Screening
COVID 19 Screening
Are you experiencing any of the following symptoms with unknown cause?
New or Worsening cough?
(Required)
Yes
No
Shortness of breath or difficulty breathing?
(Required)
Yes
No
Feeling feverish – temp
(Required)
Yes
No
Chills?
(Required)
Yes
No
Fatigue or weakness?
(Required)
Yes
No
Muscle or body aches?
(Required)
Yes
No
New loss of smell or taste?
(Required)
Yes
No
Headache?
(Required)
Yes
No
Gastrointestinal symptoms?
(Required)
Yes
No
Feeling very unwell?
(Required)
Yes
No
Have you had contact with any person with, or under investigation for, COVID-19 in the last 14 days?
(Required)
Yes
No
Have you or anyone from your immediate hoursehold travelled outside Canada in the past 14 days? (for non-essential travel)
(Required)
Yes
No
In the past 10-14 days, have you been required to quarantine or isolate by your local public health authority?
(Required)
Yes
No
If you have answered YES to any of the questions above, ATSA management requests you leave the venue and contact AHS for a covid test & isolate yourself from other participants to lower the risk of contamination to others.
Participants Name
(Required)
First
Last
Signature
(Required)
Signature required by parent or guardian if participant is under 18.
Phone
(Required)
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