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Revised Winter Season Questionnaire and Waiver

PLEASE READ THE FOLLOWING STATEMENTS, PROCEDURES, WAIVER AND QUESTIONNAIRE IN ITS ENTIRETY!

We at PSC&HS want to keep our members, coaches and staff as safe as possible while ON and OFF the ice. Please familiarize yourselves and your children with the below procedures and guidelines which will be implemented effective January 4, 2021 for the Winter Season.  If restrictions or guidelines should change, you will be notified accordingly.  This questionnaire and waiver will be required to be completed and submitted every two weeks.

Procedures

  • Sessions are limited to 20 skaters.
  • All people entering the Club will need to have completed a Questionnaire/Waiver online via smartwaiver.com (required every two weeks)
  • 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) shall 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 public bathrooms (no locker room, 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.
  • 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.
  • 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. If partner or coach tests positive for Covid-19, please refer to the Quarantine Guidelines.
  • All skaters shall do their best to stay socially distanced from other skaters while on and off 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.

Quarantine Guidelines

In the spirit of community and our responsibility to keep each other safe, the following are our guidelines for quarantining for Covid-19:

  • If you feel sick, please stay at home.  We will continue to monitor temperatures upon entrance to the Club.  Anyone with a temperature of 100.4 or over will not be allowed into the building. 
  • If you have Covid, you must meet the following criteria before returning to the Club (Club shall be informed immediately, or at least within 24 hours, of a positive test result): 10 days since symptoms first appeared and 24 hours with no fever without the use of fever-reducing medications and other symptoms of COVID-19 are improving.
  • If you test positive and are asymptomatic, you should quarantine for 10 days and monitor for symptoms.  If no symptoms develop, you may return to the Club after 10 days.  If symptoms develop, follow guidelines listed above.
  • If you are awaiting test results because you came in contact with or have been exposed to Covid-19, you must quarantine for 10 days or have a negative Covid test to return to the ice.  If you are routinely tested, such as at school or for employment, you may skate while awaiting your test results as long as you have had no known exposures and are not experiencing symptoms. If your test is positive, you must immediately, or at least within 24 hours, inform the Club of the positive test result.
  • If you are directly exposed by close contact with individual(s) with Covid, you should quarantine according to the options provided by the PA Department of Health: 

                                    *The most protective recommended quarantine period remains at 14 days post exposure.

                                    *Quarantine can end after Day 10 without testing if no symptoms have been reported during daily monitoring.

                                    *When testing resources are sufficient, quarantine can end after Day 7 if a diagnostic specimen tests negative and is

                                      collected on day 5 or thereafter and the person remains asymptomatic.

                                    *Quarantine may not be further shortened beyond the end of day 7.

As per the CDC, close contact is considered someone you were within 6 feet of who has COVID-19 for a total of 15 minutes or more; you provided care at home to someone who is sick with COVID-19; you had direct physical contact with the person [hugged or kissed them]; you shared eating or drinking utensils; they sneezed, coughed, or somehow got respiratory droplets on you)

As of March 1, 2021 the Order of the Secretary of the Pennsylvania Department of Health for Mitigation Relating To Travel is no longer in effect. Travelers should still practice appropriate public health measures to slow the spread of COVID-19 such as masking, physical distancing, and hand hygiene.

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 Club Members Name

First Name*

Middle Name

Last Name*

Phone*
First Club Members Date of Birth*
First Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

First Club Members Signature*
Second Club Members Name

First Name*

Middle Name

Last Name*
Second Club Members Date of Birth*
Second Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

Third Club Members Name

First Name*

Middle Name

Last Name*
Third Club Members Date of Birth*
Third Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

Fourth Club Members Name

First Name*

Middle Name

Last Name*
Fourth Club Members Date of Birth*
Fourth Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

Fifth Club Members Name

First Name*

Middle Name

Last Name*
Fifth Club Members Date of Birth*
Fifth Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

Sixth Club Members Name

First Name*

Middle Name

Last Name*
Sixth Club Members Date of Birth*
Sixth Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

Seventh Club Members Name

First Name*

Middle Name

Last Name*
Seventh Club Members Date of Birth*
Seventh Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

Eighth Club Members Name

First Name*

Middle Name

Last Name*
Eighth Club Members Date of Birth*
Eighth Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

Ninth Club Members Name

First Name*

Middle Name

Last Name*
Ninth Club Members Date of Birth*
Ninth Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

Tenth Club Members Name

First Name*

Middle Name

Last Name*
Tenth Club Members Date of Birth*
Tenth Club Members Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

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 Questionnaire
Have you experienced any symptoms such as fever, trouble breathing, dry cough, runny nose, sore throat, or reduction in the sense of smell or taste in the last 14 days?*
No
Yes
Have you been in close contact with someone who has tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you tested positive for Covid-19 in the last 14 days?*
No
Yes
Have you been tested for Covid-19 and are awaiting results?*
No
Yes

If you have answered yes to any of the above questions, we ask that you seek additional guidance from your medical doctor in addition to adhering to the Covid quarantine guidelines set forth by the Club

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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