LPBC COVID-19 Health Screening
Email address *
First and Last Name *
Type of Activity *
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for CoVID-19 or who has or had symptoms of COVID-19? *
Have you tested positive for COVID-19 in the past 14 days? *
Have you experienced any symptoms of COVID-19 in the past 14 days? *
I attest that my above answers are true and understand that LPBC requires me to immediately disclose if and when my response to any of the aforementioned questions changes, such as if I begin to experience symptoms, including during or outside of LPBC gatherings or engagements. My typed name below serves as my digital signature. *
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