COVID-19 Figure Skating Certification Form
This form MUST be completed by all skaters and coaches EACH time they utilize AFSC ice sessions.

To make the process more streamlined, please have this form completed 30-minutes prior to your arrival at the rink. THIS FORM NEEDS TO BE COMPLETED ON THE DAY YOU SKATE, NOT BEFORE OR AFTER.
Email address *
Name: *
Phone Number: *
Address (Street, City, State, Zip Code) *
Parent/Guardian Name:
Parent/Guardian Phone Number, if different from above:
Skater's Coach:
Certification of Symptoms:
I hereby certify to the best of my ability that the information on this form is accurate regarding myself/skater.
Do you had (skater/coach) currently have or have had COVID-19 symptoms in the past 10 days? Any of the following: Fever or chills, Cough, Shortness of breath or difficulty breathing, Fatigue, Muscle or body aches, Headache, New loss of taste or smell, Sore Throat, Congestion or runny nose, Nausea or vomiting, or Diarrhea. *
Have you (skater/coach) taken fever reducing medication in the past 6 hours? Tylenol, Ibuprofen, Aleve, Aspirin, Naproxen, or any other fever reducing medications for COVID-19 related symptoms. *
Have you (skater/coach) or anyone in your family been designated a contact of a person who tested positive for COVID-19 by a local health department? Or in the last 10 days have been placed in mandatory quarantine due to COVID-19? *
Have you (skater/coach) been tested for COVID-19 and are waiting to receive test results? *
In the last 14 days, have you (skater/coach) or anyone you live with traveled internationally to a CDC level 2 or 3 COVID-10 related health notice country; OR in the past 3 days have you returned from spending more than 24 hours in any state other than Vermont, Massachusetts, Connecticut, Pennsylvania or New Jersey? *
Notes:
If you answered YES to any of the above questions, we ask that you DO NOT ENTER the facility. In order for AFSC to continue to offer ice, we must maintain safety for all participants.

If you answered NO to all questions, your temperature will be taken with a No Touch thermometer prior to entry. If you have a temperature over 100.4, you will not be allowed to enter.

Masks are required while entering, leaving, and in the facility. Masks are encouraged to be worn by skaters on the ice when social distancing cannot be maintained. Additionally, masks will be required for any group lessons or classes in addition to social distancing on the ice. COACHES MUST WEAR A MASK AT ALL TIMES PER BETHLEHEM YMCA POLICIES.
Privacy Statement:
The information collected on this form will be used to determine only whether you may be infected with COVID-19. The information on this form will be maintained as confidential. Any questions should be directed to the Albany Figure Skating Club Board of Directors.
Email Confirmation:
You will receive an email confirmation that your form was successfully submitted. Please keep this email to show the ice monitor during check in. Please remember to social distance while waiting to be confirmed by the ice monitor. Thank you!
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy