RXCSF Youth Skiing Health Screening Form

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Complete on the day of practice, BEFORE coming to practice.

This is required to be able to join the group for that day.

Anyone who has had COVID symptoms or a positive test must have medical clearance before returning to practice.

Fill out for each child, coach/volunteer attending.

Skier name (first, last) *

Parent/guardian phone # *

In the past WEEK, have you experienced any of these symptoms that are NEW or UNUSUAL for you? *

Yes. DO NOT ATTEND PRACTICE and contact your doctor for recommendations about testing, quarantine. and medical care.

In the past 2 WEEKS, have you or a household member or close contact tested positive for COVID? Close contact is anyone you've been within 6 feet of for > 15 minutes over 24 hours (regardless of masking).

Yes. DO NOT COME TO PRACTICE. Call the county COVID hotline (585-753-5555) for required quarantine and testing.

Clear selection

In the past 2 WEEKS, have you traveled outside of New York for more than 24 hours (excluding CT, MA, NJ, PA, VT)?

Yes. DO NOT COME TO PRACTICE. Follow the NY State requirements for quarantine, testing, reporting - https://coronavirus.health.ny.gov/covid-19-travel-advisory

Clear selection

If you have answered NO to all of the above questions, you are cleared to come to practice.

If you have answered yes, then contact your doctor or the county health department COVID hotline (585-753-5555) for required quarantine, testing, and medical clearance before returning to practice.

Submit

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