Health Self-Attestation Form

Welcome to the new Health Self-Attestation Form. 

The undersigned, on behalf of the player identified below, hereby represents, warrants and acknowledges that I have read and understand my responsibilities as a Parent/Guardian according to the local guidelines, prior to participating in any town program, club, or league related activities. This includes, but is not limited to, individual or team practices, clinics, training, races, tournaments, meetings or classes. I attest that the information I am providing is true and accurate. Prior to bringing my player to participate in any related activities that they have not experienced any of the following symptoms within the last 48 hours.

Today or in the past 48 hours, have you or any household members had any of the following symptoms?

Fever of 100.4º or above, felt feverish, or had chills? Temperature must be taken before each practice/game.
Sore throat?
Difficulty breathing?
Gastrointestinal symptoms (diarrhea, nausea, vomiting?)
Abdominal pain?
Unexplained rash?
New loss of smell/taste?
New muscle aches?
Any other signs of illness?
Fatigue alone will not excuse a child from participating.
In the past 14 days, have you had close contact with a person who has had a confirmed case of COVID-19?
Close contact is defined as being within 6 feet of an individual who has tested positive for COVID-19 for more than 10 minutes while that person was symptomatic, starting 48 hours before their symptoms began until their isolation ends.
❏ The racer is not restricted from participating by a healthcare provider.

❏ The racer has not traveled in the past 14 days to or from any states restricted by
a local travel order. If so, all of the necessary
steps required by the order will be completed by the racer prior to returning to

If at any time you are unable to confirm the above criteria, the racer must be restricted
from participation and should contact their healthcare provider.

I understand that any falsification or omission of the information provided above, could
result in disqualification from participating in any Quechee related activity for no less than a year.
Sign above

If the participant has answered yes to any of the above the participant will not be allowed to participate in any Quechee Alpine Ski team until above condition can be met.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.