Participant's First Name

Participant's Last Name

Has the attendee travelled outside of Canada in the last 14 days? (Individuals are legally required to quarantine for 14 days when entering or returning to Alberta from outside Canada unless exempted by the Alberta COVID-19 Border Testing Pilot Program.) Yes No

Has the child had close contact with a case of COVID-19 in the last 14 days? Face-to-face contact within 2 metres for 15 minutes or longer or direct physical contact such as hugging. Yes No

Does the attendee have any new onset (or worsening) of any of the following symptoms:

Email address for participant

Date of floor time this is for?

Age group? 6U 8U 10U 12U Girls 12U 14U 16U

Please provide an emergency contact telephone number:

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