Junior Nordic Daily COVID Assessment (DCA)
Hello Hillside T/R/S 6:30pm Skiers!

Please complete the form below prior to every practice.

In case of transmission, we will be reaching out to all those who complete the log.

Thank you and Happy Trails!
Skier First & Last Name: *
Skier Type: *
Parent Name (if applicable):
Phone Number: *
Email Address: *
COVID Screening for Skiers:
Is your Body Temperature over 100.4 or have you had a fever in the last 72hrs? *
Are you experiencing an unusual cough? *
Are you experiencing an unusual sore throat? *
Are you experiencing unusual shortness of breath? *
Do you have any of the following symptoms that are new or unexplained (Chills, Diarrhea, Abdominal Pain, Vomiting, Fatigue, Joint Pain, Muscle Aches, New Rash, Loss of Smell or Taste, Headache, NEW congestion, NEW runny nose)? *
Have you had close contact with someone with COVID-19 in the last 14 days? *
Have you traveled outside of Alaska in the last 14 days? *
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