This questionnaire must be completed by each individual prior to participation in each on-ice or off-ice activity. This questionnaire may be completed verbally. Are you currently experiencing any of these issues? Call 911 if you are. 1. Severe difficulty breathing (struggling for each breath, can only speak in single words) 2. Severe chest pain (constant tightness or crushing sensation) 3. Feeling confused or unsure of where you are 4. Losing consciousness If you are in any of the following at risk groups, we ask that you speak with your physician prior to participating. 1. 70 years old or older 2. Getting treatment that compromises (weakens) your immune system (for example, chemotherapy, medication for transplants, corticosteroids, TNF inhibitors) 3. Having a condition that compromises (weakens) your immune system (for example, diabetes, emphysema, asthma, heart condition) 4. Regularly going to a hospital or health care setting for a treatment (for example, dialysis, surgery, cancer treatment)
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