COVID-19 Waiver Form

Please fill out this form prior to attending the Time to Shine event on May 21st. Thank you!

In the past 24 hours, have you experienced:

Fever

Fatigue

Cough

Sneezing

Muscle Aches and Pains

Sore Throat

Diarrhea

Headaches

Shortness of Breathe or Difficulty Breathing

New Loss of Smell and/or Taste

Chills

Have you recently been in close contact with anyone who has exhibited any symptoms of COVID-19?

Have you recently been in contact with anyone who has tested positive for COVID-19

I attest that the foregoing information is true and correct:

Please print name

Date

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