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PSC&HS Fall Season Questionnaire & Waiver

We at PSC&HS want to keep everyone as safe as possible ON the ice. Please familiarize yourselves and your children with the below guidelines which we will be implemented for the Fall Session:

Procedures:

All people entering the Club will need to have completed a Questionnaire/Statement: travel, illness, exposure and Covid-19 statement online via smartwaiver.com
Temperature check upon arrival in the building.
Only skaters, involved coach, and employees will be allowed in the facility during time slot. One parent per skater may enter with their child; however, parents need to sit in their child's designated space while in the building while observing (please no roaming the bulding).
Skaters & coaches may not enter the Club earlier than 15 minutes before session start time and must leave within 10 minutes of end of session.
All persons entering the Club (skaters, coaches and employees) should wear masks; masks must be worn (covering your nose and mouth) at all times while within the building (unless engaged in high intensity skating).
To minimize surface interaction: No rinkside warm up, this should be done outside.
Access is only allowed to the ice surface, rinkside, and bathroom (no lower or upper lounge admittance, limited access to skate shop).
Interaction with office will be through front office window (at entrance).
Please remember to use your social distancing on the bleachers and in front of the lower lounge while tying your skates.  Also, please remember to take all your belongings with you at the end of the session.  Please be sure to exit the Club promptly at the end of your session.
Surfaces will be wiped down continuously throughout the day. Extra time will be added to schedule to accommodate cleaning at regular intervals.
One person at the music box at any time. Music box area will be wiped down in between each session.
No shared tissue box, please bring your own.
Coaches must wear masks and teach from the side of the ice surface in taped assigned spots when possible.
Any partnering is done at your own risk as social distancing is not possible.
All skaters should do their best to stay distanced from other skaters while on the ice
Sessions will be pre-booked in a reservation system overseen by the Director of Skating.

Skate Shop sales are done by appointment only.  Please call 610-642-8700 to arrange appointment with Fran Mycek.

 

For the safety of all our skaters and our staff, if you have traveled, or plan to travel, to an area where there are high cases of Covid-19, the PSC&HS will follow the recommendation of the state of PA and request that you stay at home for a minimum of 10 days upon return to PA.  As of 10/19/20 these states include: Alabama, Alaska, Arkansas, Florida, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, North Caroline, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Wisconsin, and Wyoming.  This list is updated regularly by the Commonwealth of PA and states included in the travel quarantine can change (states may be added or deleted from the list).

You may now sign up at any time prior to a session, however, we will continue to require cancellations 24 hours in advance in order to avoid being charged for sessions. No walk-ons will be allowed.  All skaters must register on the SignUp Genius and add their name to the available slots (no "penciling" names in).

Covid-19 Disclosure and Release

Exposure to COVID-19 is an inherent risk in any public location where people are present; we cannot guarantee you will not be exposed during your visit. The CDC advises that older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from Coronavirus. Guests should evaluate their own risk in determining whether to skate. People who show no symptoms can spread Coronavirus if they are infected and any interaction with the general public poses an elevated risk of being exposed to Coronavirus. By participating in on and off-ice activities at the PSC&HS, you acknowledge and agree that you assume these inherent risks associated with attendance.

We ask that you disclose any indication of having been exposed to the Covid-19 virus. We also ask that you please inform the office if your exposure or health changes at any time after the completion of this form.

First Skaters Name

First Name*

Middle Name

Last Name*

Phone*
First Skaters Date of Birth*
First Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

First Skaters Signature*
Second Skaters Name

First Name*

Middle Name

Last Name*
Second Skaters Date of Birth*
Second Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Third Skaters Name

First Name*

Middle Name

Last Name*
Third Skaters Date of Birth*
Third Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Fourth Skaters Name

First Name*

Middle Name

Last Name*
Fourth Skaters Date of Birth*
Fourth Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Fifth Skaters Name

First Name*

Middle Name

Last Name*
Fifth Skaters Date of Birth*
Fifth Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Sixth Skaters Name

First Name*

Middle Name

Last Name*
Sixth Skaters Date of Birth*
Sixth Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Seventh Skaters Name

First Name*

Middle Name

Last Name*
Seventh Skaters Date of Birth*
Seventh Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Eighth Skaters Name

First Name*

Middle Name

Last Name*
Eighth Skaters Date of Birth*
Eighth Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Ninth Skaters Name

First Name*

Middle Name

Last Name*
Ninth Skaters Date of Birth*
Ninth Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Tenth Skaters Name

First Name*

Middle Name

Last Name*
Tenth Skaters Date of Birth*
Tenth Skaters Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Questions
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in sense of smell?*
No
Yes
Have you been in contact with someone who has tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you tested positive for Covid-19 in the past 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes
Have you traveled outside the United States by air or cruise ship in the last 14days?*
No
Yes

If you have answered yes to any of the above questions, we ask that  you seek additional guidance from your medical doctor.

Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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