JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Screening
Each skating class a skater comes to, they will need to fill out the form prior to entering the rink.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Do you or your child (or another accompanying your child to the skating lesson) or anyone you have been in contact with have any of the following symptoms? Check all that apply.
*
Fever (defined as 100.4 F degrees)
Chills
Cough
Sore Throat
Shortness of breath and/or trouble breathing
Persistent pain, pressure, or tightness in the chest
New loss of taste or smell
None of the Above
Required
Have you or others attended today’s skating session traveled outside of our local area or outside of the US within the past 14 days?
*
Yes
No
Have you, your child, or others attending today’s skating session, or anyone you have recently been in contact with tested positive for or been diagnosed as having COVID-19 or any other communicable disease?
*
Yes
No
I understand that if the answer to any of these questions is yes, I may be asked to reschedule this skating practice.
*
MM
/
DD
/
YYYY
Skaters Name
*
Your answer
Parents Name
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
