Athlete Daily Screening » Edmonton Acrobatic Gymnastics

Due to the Coronavirus (COVID-19) outbreak we are taking extra precautions with the care of every member to include session tracking, social distancing protocols and enhanced sanitation/disinfection procedures in accordance with the Alberta Heather Services.

This form MUST be filled out EVERY DAY prior to attending training.

Athlete Information
Athlete Name (First and Last)*
Date of Birth*
Date Format: MM slash DD slash YYYY
Athlete Age
Emergency Contact Information

Please provide contact information to supply to Alberta Health Services for contact tracing purposes in the event there are any reported COVID-19 illnesses that may affect your athlete or others they have been in contact with.

This information may not be the same emergency contact we have on file.
Emergency Contact Name*
Emergency Contact Phone*
Email*

Athletes under 18

Children should be screened every day by completing this checklist before going to the Gymnastics Club.
Children may need a parent or guardian to assist them to complete this screening tool.

1. Has the child:(Choose any/all possible exposures)
Traveled outside Canada in the last 14 days?*
When entering or returning to Alberta from outside Canada, individuals are legally required to quarantine for 14 days unless enrolled in the Alberta COVID-19 International Border Pilot Project
- Yes
- No
Had close contact with a case of COVID-19 in the last 14 days?*
Face-to-face contact within 2 meters for 15 minutes or longer, or direct physical contact such as hugging.
- Yes
- No
You answered "Yes" to one of the above questions - The child is required to quarantine for 14 days from the last day of exposure. o If the child is participating in the Alberta COVID-19 International Border Pilot Project, they must comply with the program restrictions at all times.
- If the child develops any symptoms, use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.

2. Does the child have any new onset (or worsening) of the following core symptoms:
Fever*
Temperature of 38 degrees Celsius or higher
- Yes
- No
Cough*
Continuous, more than usual, not related to other known causes or conditions such as asthma
- Yes
- No
Shortness of breath*
Continuous, out of breath, unable to breathe deeply, not related to other known causes or conditions such as asthma
- Yes
- No
Loss of sense of smell or taste*
Not related to other known causes or conditions like allergies or neurological disorders
- Yes
- No
You answered "Yes" to one of the above questions - The child is to isolate for 10 days from onset of symptoms.
- Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.

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 Boarder Testing Pilot Program.
- Yes
- No
Has the attendee had close contact1 with a confirmed case of COVID-19 in the last 14 days?*
Face-to-face contact within 2 meters. A health care worker in an occupational setting wearing recommended personal protective equipment is not considered to be a close contact.
- Yes
- No
You answered YES to one of the above symptoms.
If an individual answers YES to any of the questions, they are not allowed to attend or participate in any activity or program. Please follow Alberta Health regulations and recommendations prior to returning to class.

If the participant arrives exhibiting any of the above symptoms, staff has the right to refuse entry into the facility. If the participant develops any of the above symptoms, staff will implement their rapid response to symptomatic individuals’ policy.
I understand that coaches, employees, or volunteers cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each participant.
Signature

Athlete Information