Hockaway Beach 2022 Attendance & Covid Attestation Form

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Please complete this form within 24 hours of your scheduled game.

Per NYS department guidance readily available online (https://coronavirus.health.ny.gov/home the following are common symptoms of covid:
Fever or chills
Cough
New loss of taste or smell
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea

Email *

First Name *

Last Name *

Vaccination Affirmation

I am fully vaccinated against covid 19 and acknowledge that based on current CDC and NYS requirements, that I have the option to choose whether or not I will be wearing a mask.

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Covid Affirmation (select multiple checkboxes) *

I have not experienced any covid symptoms in the past 5 days, and

I have not tested positive for covid in the past 5 days, and

I have not knowingly been in close contact with anyone who has had symptoms or tested positive for covid in the past 10 days,

Required

If you answered yes to any of the above had symptoms or tested positive, please elaborate

I acknowledge that I cannot hold Womens Ball Hockey NYC liable for any exposure to covid, either caused by playing in the league, misinformation in this form, or the affirmations provided by other players via this form
*

Yes

Eligibility Self Assessment *

Based on my knowledge of the affirmation and league's implementation of the NYS honour system guidance recently published, I acknowledge that I am eligible to participate and also accept the risks of doing so

Based on my knowledge of the affirmation and league's implementation of the NYShonour system guidance recently published, I acknowledge that I am not eligible to participate.

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