Covid-19 Screening (Burford Minor Hockey)
County Screening Click Here!
Thank you, and stay safe!
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Covid-19 Screening
Please Pre Screen before arriving to participate. This also helps the County of Brant and Brant County Health Unit comply with the provincial Response Plan by knowing who has visited the building.
Contact
Please Provide Contact Info.
Reason for Visit
*
Player
Coach
Spectator
Referee
Time Keeper
Name of Participant
*
Name Parent Guardian Contact
Home Team
Select One...
Mini Mac Early
Mini Mac Late
SR IP(U7)
JR IP1(U6)
JR IP2(U6)
Novice 1 (U9)
Novice 2 (U9)
Minor Novice 1(U8)
Minor Novice 2(U8)
Team1(U11)
Team2(U11)
Team3(U11)
Team1(U13)
Team2(U13)
Team3(U13)
Team1(U15)
Team2(U15)
Team 2(U18)
Team1(U18)
Coaching Clinic
Development
Contact Phone#
*
Example: ###-###-####
Visiting Team Name
Only fill in if you are the visiting team.
Location
Date of Event
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
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April 2021
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Time of Event
*
RadDatePicker
RadDatePicker
Open the time view popup.
Time picker
Time Picker
12:00 AM
12:30 AM
1:00 AM
1:30 AM
2:00 AM
2:30 AM
3:00 AM
3:30 AM
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4:30 AM
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10:00 PM
10:30 PM
11:00 PM
11:30 PM
Location
*
Assesment
Do you have a fever greater than or equal to 38°C (100.4°F) and/or a new onset of cough or difficulty breathing?
Yes
No
Have you returned from travel outside of Canada in the past 14 days?
Yes
No
Have you been asked to self-isolate?
Yes
No
Have you been in close contact with or had unprotected exposure to a confirmed or probable case of COVID-19?
Yes
No
Have you had close contact with or had unprotected exposure to any person with an acute respiratory illness who has returned from travel outside of Canada with the past 14 days prior to their illness onset
Yes
No
Do you have flu like symptoms, runny nose, cough, sore throat, diarrhea?
Yes
No
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again
Team Sites
Mini Mac
Mini Mac Early
Mini Mac Late
Pre Novice IP (U7)(U6)
JR IP1(U6)
SR IP(U7)
JR IP2(U6)
(U8)(U9)
Minor Novice 1(U8)
Minor Novice 2(U8)
Novice 1 (U9)
Novice 2 (U9)
(U11)
Team1(U11)
Team2(U11)
Team3(U11)
(U13)
Team1(U13)
Team2(U13)
Team3(U13)
(U15)
Team1(U15)
Team2(U15)
(U18)
Team 2(U18)
Team1(U18)
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Sun Apr 18, 2021
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