LuMin House Guest Check-in
Every person visiting the LuMin House is asked to fill this out as we all work to reduce the spread of COVID. Thanks in advance for your help.
Email address *
Name *
Today's Date *
Within the last 24 hours, have you experienced any of the following? Select all that apply *
Have you been exposed toa household or close family member who has tested positive for or is suspected of having COVID 19 in the past 14 days? *
Please record your temperature below. *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy