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 jbinsfeld@parkindustries.com
Email *
I am/We are a...check all that apply *
Required
SCYHA Group *
First Name/Names *
Last Name *
Do you have any of the following COVID-19 Symptoms? (Where you can not attribute the symptom to another health condition.) *
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.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy