JV Boys Ice Hockey - Daily COVID19 Screening for SDOC practice/game (Winter 2020-21)

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Any of the symptoms below could indicate a COVID-19 infection and may put your child at risk for spreading illness to others. Please note that this list does not include all possible symptoms and individuals with COVID-19 may experience any, all, or none of these symptoms. Please check daily for these symptoms:

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Please fill out this form, the day of the practice or game before you arrive for the most accurate responses. Thank you for your cooperation.

First name *

Last name *

Grade

9th

10th

11th

12th

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Group A *

Fever (measured or subjective)

Chills

Rigors (shivers)

Myalgia (muscle aches)

Headache

Sore Throat

Nausea or Vomiting

Diarrhea

Fatigue

Congestion or runny nose

NONE of the above

必填

Group B *

Cough

Shortness of Breath

Difficulty Breathing

New loss of smell

New loss of taste

NONE of the above

必填

If TWO OR MORE of the fields in Group A are checked off OR AT LEAST ONE field in Group B is checked off, your child should stay home and not attend practice/game *

I Understand the above statement and have no reason for my child to stay home and not attend practice/game.

My child must stay home and not attend practice/game.

Section # 2: Close Contact/ Potential Exposure *

Your child has had close contact (within 6 feet of an infected person for at least 10 minutes) with a person with confirmed COVID-19

Someone in your household is diagnosed with COVID-19

Your child has traveled to an area of high community transmission (https://covid19.nj.gov/faqs/nj-information/travel-and-transportation/which-states-are-on-the-travel-advisory-list-are-there-travel-restrictions-to-or-from-new-jersey)

NONE of the above

必填

You understand If ANY of the fields in Section 2 are checked off, your child should remain home for 14 days from the last date of exposure or date of return to New Jersey. Contact your local health department for further guidance. *

Yes

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