To be completed by parent/guardian or player age 16 & over, 1 day prior to scheduled in-person rehearsal. 1Contact Information2Health Screening3Health Screening4Confirmation Your name* First Last Your child's name* First Last Member of which orchestra?* Junior Intermediate Senior Contact Phone Number* Do you or your child have any of the following symptoms?** Fever and/or chills. Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher and/or chills Yes No * Cough or barking cough (croup). Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions they already have)** Cough or barking cough (croup). Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions they already have) Yes No * Shortness of breath. Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions they already have)** Shortness of breath. Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions they already have) Yes No * Decrease or loss of taste or smell. Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already have** Decrease or loss of taste or smell. Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already have Yes No * Nausea, vomiting and/or diarrhea. Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have** Nausea, vomiting and/or diarrhea. Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have Yes No Have you and/or your child had close contact with someone who is sick or has confirmed Covid-19 in the past 14 days?* Yes No Have you and/or your child returned from travel outside of Canada in the past 14 days?* Yes No Because you answered YES to any of the above questions, please stay home and self-isolate. We will re-book the audition if space remains in the orchestra.* I agree Confirmation*I confirm that all information provided is true to the best of my ability. I understand that prior to entering the rehearsal building, my child/myself will be given a touchless temperature check and may be asked to re-confirm answers to this questionnaire. I confirm
