BCH Pre-Ice Time Player & Parent COVID Screening
Please read through the questionnaire and answer all of the questions truthfully.
*Players who arrive at the arena and appear to be symptomatic will not be allowed to participate.
*If your player is not feeling well, or showing any signs of any illness please keep them home.
*If you have any symptoms or answer yes to any of the questions you must stay home for a minimum of 24 hours after the last symptom subsides.
*Please notify the coach if your child is not attending and the reasons for missing, this is for tracking purposes.
*The questionnaire must be completed by each player and the one parent who is attending with that player that ice time.
*This form needs to be completed for every entry into the arena for both games and practices.
Player Name (Last, First)
Parent Name (Last, First)
Contact Phone Number - Parent
Player Age Division (eg. U15)
What arena will you be attending?
Are you currently experiencing any of these issues? Call 911 if you are.
Severe difficulty breathing (struggling for each breath, can only speak in single words)
Severe chest pain (constant tightness or crushing sensation)
Feeling confused or unsure of where you are
None of the above
If you are in any of the following at-risk groups, we ask that you speak with your physician prior to participating.
Getting treatment that compromises (weakens) your immune system(for example, chemotherapy, medication for transplants, corticosteroids, TNF inhibitors)
Having a condition that compromises (weakens) your immune system(for example, lupus, rheumatoid arthritis, immunodeficiency disorder)
Having a chronic (long-lasting) health condition(for example, diabetes, emphysema, asthma, heart condition, COPD)
Regularly going to a hospital or health care setting for a treatment(for example, dialysis, surgery, cancer treatment)
Cleared by physician
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