Post Season Ice Contact Tracing
Starting March 1, 2021
Player or Coach 1 Full Name
*
First Name
Last Name
Player or Coach 2 Full Name
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Session Date
*
-
Month
-
Day
Year
Date
Session Time
*
Hour Minutes
AM
PM
AM/PM Option
Which session(s) are you here for?
*
Mite
Squirt
Peewee
Bantam
High School
Goalies
Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?
*
Yes
No
Have you experienced any flu-like symptoms in the last 14 days, including the following?
*
Yes
No
Fever Greater Than 100.4 degrees Fahrenheit
Cough
Difficulty Breathing/Shortness of Breath
Fatique
Chills, Muscle Aches
Runny Nose/Nasal Congestion (that is new or different)
Sore Throat
Loss of Taste or Smell
New Gatrointestinal Issues
Submit
Should be Empty: