SOTD COVID DAILY SCREENING
Parent or Guardian
Required if participant is under 18yrs
Do you have any of the following symptoms: fever, new or existing dry cough, difficulty breathing, fatigue and loss of taste or smell?
Have you travelled outside of Canada in the past 14 days?
Do you have a fever of 38C (100.4F) or higher?
Are you experiencing a new or worsened cough, shortness of breath, or sore throat?
Are you experiencing muscle aches, joint pain, or heightened fatigue (related to flu-like symptoms)?
Are you experiencing new loss of your sense of smell or taste?
CONTACT WITH POTENTIAL INFECTION
Does anyone living in your household have any of the aforementioned symptoms? (including: fever, cough, shortness of breath, sore throat, flu-related aches & pains, flu-related fatigue, or new loss of smell/taste?)
Have you been in close contact (within 2 metres) or prolonged contact with anyone with a confirmed or probable case of COVID-19 in the past 14 days?
If you answered YES to either of the above questions, please do not enter Spirit of the Dragon - explain your situation below to be discussed with an instructor..
Feel free to email to discuss your answers or concerns with one of our instructors.
You can contact us at firstname.lastname@example.org
Electronic Signature and Acknowledgement
Enter the date and your full name to acknowledge your electronic signature of this document.