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DELAWARE DEPARTMENT OF PUBLIC HEALTH CONTACT TRACING FORM

In compliance with Delaware Department of Public Health guidelines, the Centre Ice Arena is required to provide contact tracing for every person that enters the building.  Failure to comply with this requirement will result in dismissal from the building with forfeiture of all fees paid to date. Providing the person(s) name, address, phone number (cell) and email address is a public health requirement and will only be used by public health officials if you need to be advised of any possible exposure to the COVID-19 virus.

PLEASE LIST ADDITIONAL NAMES OF INDIVIDUALS LIVING IN THE SAME HOUSEHOLD THAT ARE ENTERING THE FACILITY

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