Online Forms

2. 
3. Town of Hinton COVID Screening and Building Access Sheet
5. Please provide answers to all the below to receive access to Rec Centre - Thomson Arena. This additional information requirement is part of the Health and Safety Departments work to enable public access to our facility, while also allowing contact tracing and proper protocals to protect our employees and public.
   
   A false submission to this document leading to any exposure or risk will be prosecuted to the fullest extent of the law.
7. Personal Information
9. First Name*
10. Last Name*
12. Agency/Organization
14. Purpose of Visit*
18. COVID-19 Screening Questions
    Please review/check these questions (related to the AHS COVID-19 Self Assessment tool) every time before signing in. Thank you.
20. Are you a Traveller returning to Alberta from outside Canada in the last 14 days: *

    1. Yes

    1. No
22. Do you have any of the following symptoms: *

    1. fever
    2. cough
    3. shortness of breath

    1. difficulty breathing
    2. sore throat

    1. runny nose
    2. no
24. Access Will Not Be Granted

    You have answered positively to one of the above questions. This indicates a risk to our staff base and public accessing the facility. Please come back after mandatory quarantine procedures are complete. As such, you will not be permitted access to the facility. Do you understand?

    1. Yes

    1. No
26. Please provide an email address for further information.
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field