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PSC&HS Winter Season Questionnaire and Waiver

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

For the Winter Season beginning November 1, 2020:

We will NO longer be requiring pre-registration or using SignUp Genius.
Sessions are limited to 20 skaters.

Since sessions are now leveled we do not anticipate any issue for members getting onto sessions.
To help us ensure our typically crowded evening “high” session does not reach capacity, we have given our High level skaters two choices. They may only skate on one of the designated “High” sessions per day.
Our priority is to keep all our members, staff and coaches safe so safety protocols will still be in place and will be reevaluated monthly. If restrictions and guidelines change, we will make changes accordingly.
Please familiarize yourself with our safety protocols and waiver that will still be required every two weeks.

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. 
  • 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 and on the ice.
  • 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).
  • Every skater should select a taped space on a chair or the bleachers to leave their bag or belongings and to tie their skates. This space should be their “socially distant” spot for the duration of the session.  Please remember to continue to social distance while on the bleachers or sitting in front of the lower lounge.
  • 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.
  • No shared tissue box, please bring your own.
  • 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 limited to a maximum of 20 skaters on the ice.
  • At this time, we are not allowing any non-member skaters on the Winter Season sessions.  Skating is available to members only.

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

PSC&HS will follow the order issued by the Pennsylvania Secretary of Health effective 11/25/20 as follows:

The Secretary of Health issued an order requiring travelers over age 11 entering Pennsylvania from locations outside the Commonwealth, including Pennsylvanians who are returning home from locations outside the Commonwealth, to produce evidence of a negative COVID-19 test or place themselves in travel quarantine for 14 days upon entering, unless they receive a negative test result during the 14-day travel quarantine period.  If someone cannot get a test or chooses not to, they must quarantine for 14 days upon arrival in Pennsylvania.

This does NOT apply to:

  • Individuals traveling to and from the Commonwealth for the purposes of work.
  • Individuals who are returning to the Commonwealth after traveling outside the Commonwealth for less than 24 hours. 
  • Individuals traveling to and from the Commonwealth for medical reasons, including individuals providing comfort and support to a patient.
  • Military personnel traveling to the Commonwealth by order or directive of a state or Federal military authority.
  • Individuals in transit through the Commonwealth to another destination, provided that the time spent in the Commonwealth is only the amount of time necessary to complete the transit, make use of travel services, such as a highway rest stop, or make necessary travel connections.
  • Individuals traveling to comply with a court order, such as child custody, or other exemptions issued by guidance.

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 Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seed 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 Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

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

Third Skaters Name

First Name*

Middle Name

Last Name*
Third Skaters Date of Birth*
Third Skaters Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

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

Fourth Skaters Name

First Name*

Middle Name

Last Name*
Fourth Skaters Date of Birth*
Fourth Skaters Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

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

Fifth Skaters Name

First Name*

Middle Name

Last Name*
Fifth Skaters Date of Birth*
Fifth Skaters Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

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

Sixth Skaters Name

First Name*

Middle Name

Last Name*
Sixth Skaters Date of Birth*
Sixth Skaters Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

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

Seventh Skaters Name

First Name*

Middle Name

Last Name*
Seventh Skaters Date of Birth*
Seventh Skaters Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

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

Eighth Skaters Name

First Name*

Middle Name

Last Name*
Eighth Skaters Date of Birth*
Eighth Skaters Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

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

Ninth Skaters Name

First Name*

Middle Name

Last Name*
Ninth Skaters Date of Birth*
Ninth Skaters Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

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

Tenth Skaters Name

First Name*

Middle Name

Last Name*
Tenth Skaters Date of Birth*
Tenth Skaters Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seed 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 Information
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?*
No
Yes
Have you tested positive for Covid-19?*
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
Have you traveled within the United Staes by air, bus or train within the past 14 days?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seed 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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