GC Hockey Health Screening Before participating
Please submit the following question. We want to ensure that all campers and staff members are healthy and ready to go.
Last name / First name *
Date of birth *
MM
/
DD
/
YYYY
Parent Name *
Cell Number *
978-555-5555
Town / City *
What type of payment for the session *
Required
Covid-19 Health screening questions *
Yes
No
Fever (Temperature over 100F),felt feverish or had chills
Shortness of breath
Cough
Abdominal pain
Unexplained rash
Fatigue
Headache
New loss of taste/smell
Muscle aches
Recently travelled
Gastrointestinal symptoms (diarrhea, nausea, vomiting)
Any other signs of illness
Have you given your child medicine to lower a fever
In the past 14 days, have you had close contact with a person known to be infected with the novel coronavirus (COVID-19)?
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