Screening form for game entrance

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Due to the global pandemic, Section One and the Mahopac Central School District will be limiting access to any and all facilities as per the Mahopac Central School District Guidelines. As a result, the following rules and stipulations shall be adhered to at all Mahopac Central School District Athletic events.

1. Only TWO individuals per athlete will be permitted access to an athletic event.
2. EACH spectator MUST Complete their own screening form individually.
3. Family members may sit together but all other parties must maintain at least 6 feet from other spectators
4. All individuals are expected to have and properly wear appropriate face coverings and practice social distancing
5. Temperatures will be taken before you are permitted into the athletic event.

Email *

Player Last name *

Best Contact Number *

Player First Name *

Spectator Last Name *

Spectator First Name *

Select a team *

V Volleyball

JV Volleyball

M Volleyball

V Football

JV Football

Swimming

Cheerleading

Marching Band

Other:

High School you are associated with *

Have you had a positive result from a COVID-19 viral test in the past 14 days? *

Yes

Have you come in contact with a person who has had a positive result within the past 14 days? *

Yes

Is your temperature currently 100 degrees or higher? *

Yes

Are you currently taking fever reducing medicine? *

Yes

Have you traveled internationally or to an identified state within the last 14 days, thereby requiring a 14 day quarantine? *

Yes

Are you awaiting the results of a Covid-19 test *

Yes

within the past 10 days have you experienced any of the following symptoms? *

Yes

Fever or 100 degree F temperature or possible fever symptoms?

Congestion or runny nose?

Cough

Fatigue

Sore Throat

Headache

Trouble breathing, shortness of breath, or sever wheezing

Chills or repeated shaking with chills

Muscle Aches

Loss of smell or taste, or a change in taste

Any additional/notes *

I have read the self health assessment checklist and know the contents thereof; that the same is true to my knowedge and have given the answers set forth above knowing that the Mahopac Central School District will rely upon them in admission into the athletic event. *

Yes

A copy of your responses will be emailed to the address you provided.

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