Arlington Hockey Club Health Form

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ATHLETES AND COACHES:
IF YOU HAVE BEEN CONTACTED BY DUTCHESS COUNTY CONTACT TRACERS OR NOTIFIED BY THE SCHOOL DISTRICT OR A SPORTS TEAM THAT YOU HAVE BEEN IN DIRECT CONTACT WITH A COVID POSITIVE PERSON YOU MAY NOT ATTEND PRACTICE UNTIL THE SPECIFIED LENGTH OF TIME FOR YOUR QUARANTINE HAS PASSED.
The board will no longer be taking temperatures outside the rink. The cold temperatures make the thermometers unreliable. We ask for the athletes and parents to cooperate in a new addition to this form which is the taking of your temperature before you leave home to enter the rink. Please document your temperature in this form.

Arrive fully dressed to the rink, except· for skates. Skates are to be put on in designated areas.

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 *

Please document your temperature at the time of practice today *

0 points

Practice Date *

YYYY

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

1 point

Yes

Clear selection

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

0 points

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?

1 point

Yes

Clear selection

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

1 point

Yes

Clear selection

If your answers to all of the questions are "No" please click Pass Screening. If your answers to all of the questions are "Yes" please click Fail screening and notify your coach immediately that you will not attend practice. *

1 point

Pass

Fail

Submit

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