Name * First Name Last Name Phone *Example : 6472613002Session Date * Date Format: mm/dd/yyyy Date Format: MM slash DD slash YYYY Time * Hours : Minutes AM PM I am attending: * Small Group Lessons Private Lessons Semi Private Lessons 1) Do you have any of the following symptoms: Fever, new or worsening cough, shortness of breath, sore throat or difficulty swallowing, new smell or taste disorders, nausea/vomiting, diarrhea, abdominal pain, runny nose or nasal congestion * No Yes 2) Have you been in contact with someone with COVID-19 in the last 14 days? * No Yes 3) Have you been out of the country within the last 14 days? * No Yes * IF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE QUESTIONS PLEASE DO NOT ENTER THE FACILITY. TAKE THE OFFICIAL ONTARIO SELF ASSESSMENT TOOL AND FOLLOW IT’S RECOMMENDATIONS.Consent *By submiting this form I {name} certify that the information I've entered in this form is true and correct to the best of my knowledge. I further understand that it is my responsibility to IMMEDIATELY inform ICM TENNIS of any changes to the answers I have provided. I certify*CAPTCHA
