* Required

Day of Special Event COVID-19 Self-Report Screening Form

Please submit this form for each individual attending the event.

Event Attendee Self-Report

Specify Fahrenheit (F) or Celsius (C)​
Fever (above 100.4 / 38), fatigue, cough, any difficulty breathing, sore throat, muscle aches, headache, nausea or vomiting, diarrhea, new loss of taste or smell. ​​​​

For the safety of all attendees, please stay home and refrain from attending the event.

For the safety of all attendees, please stay home and refrain from attending the event.


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