Monday – Wednesday – Thursday School Term

For your safety and the safety of others, please take a moment to complete this mandatory health questionnaire BEFORE you get to the entrance of The Ice Station.

(* Required fields)
First Name *

Last Name *

ID Number *

Email *

Mobile Number *

Are you experiencing a sudden onset of at least one of the following symptoms:
• Cough
• Sore throat
• Shortness of breath
• Fever, a temperature of 37.3°C or higher, or a history of fever in the last 14 days
• Chills
• Body aches including headaches
• Loss of taste/smell
• Nausea, diarrhoea or vomiting, or all
YesNo

In the past 10 days have you been in close contact or a closed space with a COVID-19 confirmed case? YesNo

(In this case close contact refers to being in contact with a person who had confirmed coronavirus disease but did not have any symptoms, had face-to-face contact within 1 metre of a COVID-19 positive person, or was in a closed space for more than 15 minutes with COVID-19 positive person.)

Terms and Conditions

Yes I agree to the above linked Term and Conditions and to having my temperature checked.

Upon submitting this form you will receive an email confirmation of this Health status inquiry. Either print and bring to The Ice Station or show email on your mobile device to The Ice Station staff member on duty.
Please leave this field empty.
Then check your email.