BCHL COVID-19 TRACING FORM (Brantford Community Hockey League)
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BCHL COVID-19 TRACING FORM
PLEASE COMPLETE THIS FORM BEFORE COMING TO EVERY PRACTICE OR GAME. THIS IS MANDATORY BEFORE ANYONE IS ALLOWED IN THE ARENA'S OR ON THE ICE. THIS FORM CAN BE COMPLETED UP TO 2 HOURS BEFORE COMING TO THE ARENA. If you answer YES to any of these questions, please notify your Coach and Parent Ambassador RIGHT AWAY via email or phone and please stay home.
Player Full Name
*
First and Last Name
Parent Full Name
*
First and Last Name
Phone Number
*
Example: ###-###-####
What team are you with?
*
Select One...
HL - Season #2 U21 - Team 1
HL - Season #2 U21 - Team 2
HL - Season #2 U21 - Team 3
HL - Season #2 U21 - Team 4
HL - Season #2 U15 - Team 1
HL - Season #2 U15 - Team 2
HL - Season #2 U15 - Team 3
HL - Season #2 U15 - Team 4
HL - Season #2 U13 - Team 1
HL - Season #2 U13 - Team 3
HL - Season #2 U13 - Team 4
HL - Season #2 U13 - War Pigeons
HL - Season #2 U11 - Anacondas
HL - Season #2 U11 - Kings
HL - Season #2 U11 - Knights
HL - Season #2 U11 - Leafs
HL - Season #2 U9 - Avalanche
HL - Season #2 U9 - Flames
HL - Season #2 U9 - Hornets
HL - Season #2 U9 - Rebels
HL - Season #2 U7 - Fluffy Bunnies/ Tigers
HL - Season #2 U7 - Green Machine/ Kraken
HL - Season #2 Little Saints - Little Saints
Do you have any of the following?
*
Fever/chills
New cough
Difficulty breathing
Shortness of breath
Runny nose or congestion
Unusual level of fatigue
Unusual Headache
Nausea/Vomiting
Loss of appetite
Feeling unwell for no reason
NO SYMPTOMS
Check All That Apply
Has someone you are in close contact with tested positive for COVID-19?
*
YES
NO
Have you returned from travel outside of Canada in the past 14 days?
*
YES
NO
Do you live with someone who is awaiting COVID-19 tests results and has been instructed to self-isolate.
*
YES
NO
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again
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