COVID COMPLIANCE FORM
We welcome you to "Sunday at the Farm", this October 24, 2021 at Alma Backyard Farms with Chef Charles Akau.

In order to comply with COVID-19 restrictions please fill out the form prior to arrival and present at the door to gain entry. If you answered yes to any of the questions below or have any COVID-19 symptoms, youm unfortunately may not be allowed access to this event.

We appreciate your time and thank you for your patience as we make sure this is a safe experience for our community.
Email *
Have you experienced any of the following symptoms in the past 48 hours? *
Required
Within the past 14 days, have you been in close physical contact ( 6 feet or closer for at least 15 minutes) with a person who is known to have laboratory confirmed COVID-19 case or with anyone who has any symptoms consistent with COVID-19? *
Have you been or are you isolating or quarantining because you have been exposed to a person with COVID-19 or are worried you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID 19? *
Are you currently waiting on the results of a COVID-19 test? *
Do you consent having your temperature checked, wash your hands or sanitize and keep your mask on at all times, except to drink and eat? *
Do you agree to alert FIlAm Arts at gtongi@filamarts.org if you test positive for COVID-19 before, during or within 14 days of today's event? *
Full Legal Name *
Email *
Cellphone Number *
Please Initial your first and last name as a digital signnature that you have understood and answered truthfully to the best of your knowledge regarding this COVID-19 screening form? *
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This form was created inside of FilAm ARTS.