5.24 USA Hockey Arena Health Check

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For the safety of all participants and spectators, and to allow hockey and skating at USA Hockey Arena, USA Hockey requires that a Health Check form be completed for each person entering the Arena.

Please Check Box: *

Participant

Spectator

Required

Name (Participant) *

Name (Spectator) *

Group/Team *

Scheduled Ice Date *

Scheduled Ice Time *

Email *

Cell Phone # *

Since your last visit to USA Hockey Arena, have you experienced any of the following? Please check all that apply. *

A fever (100.4 degree F or higher) or a sense of having a fever

A new cough or shortness of breath that you cannot attribute to another health condition

A sore throat that you cannot attribute to another health condition

A runny nose that you cannot attribute to another health condition

Head or body aches that you cannot attribute to another health condition

Nausea, vomiting or diarrhea that you cannot attribute to another health condition

Loss of taste or smell that you cannot attribute to another health condition

Have had contact with someone with COVID-19 in the last 14 days?

None of the above

Required

Please read the following and check Yes below: As a condition of entry into USA Hockey Arena, I agree to follow all USA Hockey Arena requirements for participating or attending events in the Arena, which include the requirement to wear a mask in all areas, social distancing, entry locations, parking, locker room usage, etc. Your contact information may be used contact tracing and other Arena communications. *

Yes

Required

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