KBC SCREENING TOOL

Participant/Coach Information
Kingsway Boxing Club Ltd. does NOT share any of the below contact information or emails with anyone or any other companies. We also do NOT send out any advertisements via e-mail. The information you provide is strictly confidential.
Date Of Screening*
Please note that this screening tool should not be done more than 24 hours prior to visit

***Unless for the purpose of updating vaccination status***
Date Format: DD slash MM slash YYYY
Full Name Of Participant*
First Last
Email*
You will be sent a confirmation email with your screening results. Please present this to your trainer.
MANDATORY SCREENING QUESTIONS
1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.
Do you have any Flu-Like Symptoms*
Fever or chills
Difficulty breathing or shortness of breath
Sore throat, trouble swallowing
and/or
Not feeling well, extreme tiredness, sore muscles
- No
- Yes
3. Have you had close contact with a confirmed or probable case of COVID-19?*
- No
- Yes
4. Vaccine Verification (Optional)
- ✅ Verification Complete/Under 12 years old
- Pending
  (if you make this selection, please move onto Next Step or contact us directly if you require assistance)
Results of Screening Questions:
If the individual answers NO to all questions from 1 through 3, they have passed and can enter the workplace.

If the individual answers YES to any questions from 1 through 3, they have not passed and should be advised that they should not enter the workplace (including any outdoor, or partially outdoor, workplaces). They should go home to self-isolate immediately and contact their health care provider or Telehealth Ontario (1 866-797-0000)to find out if they need a COVID-19 test.
WAIVER
Agreement Waiver*
I verify the above answers to be true and hereby release and hold harmless The Club, its agents, officers and employees, and any affiliated companies from any liability with respect to any injury of any nature suffered by me or to my property arising out of or in any way connected with my, or my children’s participation in any boxing or such related activity from the below date forward.
- I Agree
  *Participant must have hit their 18th birthday to accept the agreement. If you are the parent or guardian, please see the next section.
  (by submitting this form and checking this box works as your digital signature)
WAIVER OF LIABILITY FOR ALL CLAIMS AND RELEASE OF LIABILITY*
PLEASE READ CAREFULLY BEFORE SIGNING: KBC Waiver, Terms & Conditions
- I have read and agree to: WAIVER OF LIABILITY FOR ALL CLAIMS AND RELEASE OF LIABILITY
  By digitally signing, the Participant (named in form) and/or the Participant’s Guardian understands and acknowledges the terms outlined above.
Digital Signature (Participants Under 18 Years Of Age)
If the Participant is under 18 years of age, please digitally sign the full name below of Parent or Guardian who is taking responsibility for this waiver.

Thank You For Keeping Our Community Safe

The Kingsway Boxing Family has been back to training since June. As we build routines, return to work and kids go back to school, it’s important to continue keeping our community safe! Please be aware of any possible symptoms and contact us if you’re unsure.

Our staff, trainers and coaches will be following strict protocols limiting contact and ensuring the safety of our clients. In addition to cleaning in between clients and classes, a deep clean and sanitization of all locations are conducted at the beginning and end of each day.

Thank you for your support!

NOT 100%? READ NEXT PROTOCOLS

Participant/Coach Information

MANDATORY SCREENING QUESTIONS

Results of Screening Questions:

WAIVER