SCYHA COVID-19 Questionnaire
This questionnaire must be completed for all players every session/each day before they will be allowed on the ice. Complete this COVID-19 health questionnaire prior to practice/game at the MAC. If your skater is experiencing COVID-19 related symptoms OR had close contact with someone diagnosed with COVID-19, please contact Jenna Binsfeld immediately and we ask that you keep your skater home to protect others. Please contact Jenna if you have any COVID-19 related questions.
Jenna's contact information: (320) 492-4446 or
I am/We are a...check all that apply
JR Mite Teams 1 2 3 4
JR Mite Teams 5 6 7 8
Mite Teams 1 2 3 4
Mite Teams 5 6 7 8
Bantam B1 Red
Bantam B2 Black
Peewee B Red
Peewee B2 Black
Squirt B1 Red
Squirt B2 Black
Do you have any of the following COVID-19 Symptoms? (Where you can not attribute the symptom to another health condition.)
Fever (100.4 or greater), or a sense of having a fever/feeling feverish (chills, sweating)
A new cough
A new shortness of breath
A new sore throat
New muscle aches that are not caused by a specific activity (such as physical exercise)
A new headache
New loss of smell or taste
Vomiting or diarrhea
Are you waiting for results of a COVID-19 test to confirm infection?
Have you been diagnosed with COVID-19 and not yet cleared to continue isolation?
I have experienced NONE of these
To the best of your knowledge, have you had close contact with (been within 6 feet for at least 15 minutes) or cared for someone diagnosed with COVID-19 in the past 14 days?
A copy of your responses will be emailed to the address you provided.
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