I am experiencing cold or flu-like symptoms. Yes No In the last 14 days, have you travelled outside of Canada and been advised to quarantine? (as per federal quarantine requirements)* Yes No I have knowingly been in contact with someone with a confirmed case of COVID-19 or someone displaying symptoms of the COVID-19 virus. Yes No Athletes Name Athletes First Name Athletes Last Name Parent and/or Legal Guardians Name (if athlete is under 18 years old) Parent and/or Guardian First Name Parent and/or Guardian Last Name Date Masks are required at all times when in the Canadian Ice Academy facility.If you answered YES to any of the above questions, you will be denied entry to the Canadian Ice Academy for 14 days. If you make false statements on your Declaration Form, your Membership/Contract to the facility may be suspended or even terminated. This Health Screening questionnaire has been developed based on the current Ontario Ministry of Health Self-Assessment Tool.PhoneThis field is for validation purposes and should be left unchanged.