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Hockey Hut COVID-19 Screening
This form must be completed prior to and each time you plan to attend camps or lessons (or observe) at Hockey Hut
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* Indicates required question
Email
*
Your email
Player / Parent / Observer Name
*
Your answer
Practice Date
*
MM
/
DD
/
YYYY
Have you tested positive for COVID-19 in the past 14 days?
*
Yes
No
Have you knowingly been in close contact in the past 14 days with anyone who has tested positive for COVID-19 or who has had symptoms of COVID-19?
*
Yes
No
Have you traveled to any of the states on the NYS Quarantine list in the past 14 days?
*
Yes
No
Have you had any of these symptoms in the last 48 hours? (select all that apply)
*
Cough
Shortness of breath or difficulty breathing
Fever
Chills
Muscle Pain
Sore Throat
Nausea or Vomiting
Diarrhea
New Loss of Taste or Smell
NONE
Required
If you indicated yes to questions 1-3 you cannot return to the rink until the 14 day quarantine period has ended. If you have any symptoms listed in question 4, do not attend practice until cleared by a physician.
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