Mound-Westonka Hockey Association Quick Entry Check-In Form
This form follows the MDH guidelines for contact tracing and daily symptom tracking. This form is required to be completed for each participant upon arriving at either Thaler or POND Arena for any practice/scrimmage/game during the 2020-21 season. Please do not attend the MWHA event if you answered "yes" to any of the below health screening questions or have a pending COVID-19 test. Contact your health care provider for recommendations.
Date of Attendance *
PLAYER 1 First and Last Name *
PLAYER 2 First and Last Name
PLAYER 3 First Last Name
Name of Parent/Guardian *
Parent/Guardian Email Address *
Please Indicate Your Group or Pod (if a Coach/Volunteer/Instructor - check the box labeled "Coach/Volunteer/Instructor *
In the past 24 hours, have you had any of the following COMMON symptoms: a fever of 100.4 or more, new onset or worsening cough, difficulty breathing, or new loss of taste/smell? *
In the past 24 hours, have you had two (2) or more of the following LESS common symptoms; sore throat, nausea, vomiting, diarrhea, chills, muscle pain, excessive fatigue, new onset severe headache, new onset nasal congestion or runny nose? *
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