Arlington Hockey Club Health Form

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Please review the protocol’s for TP below. It is expected that athletes will fill out this form every time they attend a practice at Trinity Pawling Tirell Rink, an off ice practice at East Fishkill Roller Hockey Rink OR a game unless another form is indicated.

Note:

Arrive fully dressed to the rink, except· for skates. Skates are to be put on in designated areas.
Temperature will be taken outside the doors before you enter the rink
Parents/ Guardians are not permitted in the rink for practices. Parents should stay in their cars.
All warmups are to be done prior to entering the building.

Please enter and exit through designated doors and follow all posted signage.
Masks/ face coverings are required to be worn by all individuals inside of the facility. Skaters may take their masks off before stepping on the ice.
You may arrive 15 minutes before and depart within 15 minutes after the session.

Please let us know if you have any questions.

See you at the rink!

Email *

Name *

Practice Date *

YYYY

Have you traveled to any of the listed on the NY Quarantine Travel Guidelines in the last 14 days?

Yes

Clear selection

Have you experienced any of the following symptoms of Covid 19 in the last 48 hours?

Fever

Cough

Chills

Shortness of Breath of Difficulty Breathing

Nausea or Vomiting

Muscle Pain

Sore Throat

Diarrhea

Loss of Taste and or Smell

None of the Above

Other:

Have you tested positive for Covid 19 in the past 14 days?

Yes

Clear selection

Have you knowingly been in close contact with a person who has tested positive for Covid 19 or exhibited symptoms in the last 14 days?

Yes

Clear selection

If you indicated yes to any of the above Questions you can not return to the rink for 14 days. If you have any symptoms listed in question 2 you need to be cleared by a physician before you can attend practice.

YYYY

Submit

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