COVID-19 Screening Form 2021-2022 (Clarington Minor Hockey Association)

Print COVID-19 Screening Form 2021-2022
  1. Terms and Conditions:

    I acknowledge that I am submitting this screening form no earlier than 12 Hours prior to the scheduled session.  I acknowledge that failure to do so may compromise the participant or the parent/guardian admission into the scheduled program. 
Session Information
  1. RadDatePicker
    Open the calendar popup.
  2. Visiting Teams- choose the correct age group and level
Participant, Parent/Guardian Information
Please enter the name of the Participant and parent/guardian who will be arriving with the participant at their session.
  1. Enter Referee or Time Keeper if applicable
  2. Example: ###-###-####
  3. Example: [email protected] Your submission will be sent to this address.
  1. Symptoms:

    Are you experiencing any of the following:

    * Fever or Chills
    * Difficulty Breathing or shortness of breath
    * Cough
    * Sore throat, trouble swallowing
    * Runny nose/stuffy nose or nasal congestion
    * Loss of Taste or Smell
    * Generally Not Feeling Well
    * extreme tiredness, sore muscles
    * Nausea, Vomiting, Diarrhea

    If you answered Yes to any of these symptoms, stay home and do not enter the arena.
Close Contact Notification
Human Validation
Printed from on Friday, October 15, 2021 at 10:34 PM