COVID-19 Screening Questions

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Please answer the questions below for yourself and any guests (parents and skaters can complete one form). All skaters and guests must also take their temperature before getting on the ice or entering to watch your skater.

If you answer "Yes" to any of the questions, please do not enter the rink.

Thank you for your cooperation and keeping the Southern NH Skating Club a safe place to skate!

Email *

Your name *

Guest names

Do you have any of the following symptoms of COVID-19: 1. Fever (a documented temperature of 100.4 degrees Fahrenheit or higher) or are feeling feverish; 2. Respiratory symptoms such as a runny nose, nasal congestion, sore throat, cough, or shortness of breath; 3. General body symptoms such as muscle aches, chills, and severe fatigue; 4. Gastrointestinal symptoms such as nausea, vomiting, or diarrhea; or 5. Changes in your sense of taste or smell? *

Yes

Have you been in close contact with someone in the prior 10 days who has tested positive for COVID-19? *

Yes

Have you traveled internationally (outside of the U.S., except for essential travel to/from Canada) or by cruise ship in the prior 10 days? *

Yes

A copy of your responses will be emailed to the address you provided.

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