COVID-19 Health Check - U11 Donoghue (Lakefield Minor Hockey)

Print COVID-19 Health Check - U11 Donoghue
Once you have completed this form your coach Darryl Donoghue will receive a copy. You may only complete this form no sooner than 4 hours and no later than 1 hour before your scheduled ice time.
U11 (AT) Donoghue
Who is this screening form being completed for?
  1. First and Last Name - Player/Bench Staff
  2. First and Last Name or enter NO if player attending alone
  3. A copy of your form submission will be sent to this address as confirmation
Screening Questions
If you answer "YES" to any of the questions under this section, do not attend an arena. Contact your child's health care provider for further advice or assessment.
  1. Personal information is collected under the authority of the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020, Ontario Regulation 364/20. 

    The information will be used to screen for COVID-19 risk factors prior to entering a County of Peterborough facility or participating in a hockey program.

    In the event of a confirmed COVID-19 diagnosis that coincides with your visit, by completing and submitting this form, you consent to the Lakefield Minor Hockey COVID-19 Coordinator sharing your name and contact information with Peterborough Public Health, for purposes of contact tracing to reduce the spread of COVID-19.

     

Human Validation
Printed from lakefieldminorhockey.ca on Saturday, December 5, 2020 at 1:05 PM