Festive 5k Covid Check | website

613-640-0392

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BROCKVILLE LEGION TRACK AND FIELD CLUB

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Brockville Festive 1k and 5k COVID Check

Do you have a cough, fever, sore throat, change in taste or smell, headache, runny nose or difficulty breathing?

No

Yes

Have you had contact with anyone suspected or confirmed to have COVID-19 in the past 14 days?

No

Yes

Have you been outside of Canada within the last 14 days?

No

Yes

Have you been in close contact with anyone who has been outside of Canada within the past 14 days and has COVID-19 symptons?

No

Yes

Date this form is for:

I understand that by submitting this form, I am agreeing to follow the rules and regulations surrounding training and competing in a COVID-19 pandemic environment. These are including but not limited to, proper hand hygiene, no sharing of water bottles, sanitizing of surfaces, physical distancing, limited group sizes for practice and competitions and follow all coaches and volunteers safety instructions.

I understand that answering "YES" to any of the questions above results in my ineligibility to partake in the Brockville Festive 5k as an Athlete, Coach, Spectator or volunter and I am not allowed to attend the competition site. It is recommended that you follow up wih your local heath unit.

Thanks for submitting!

613-640-0392

125 Stewart Blvd Brockville ON Canada

©2019 BY BROCKVILLE LEGION TRACK AND FIELD CLUB.