PITTSBURGH PERFORMANCE PROJECT '21-'22 Season COVID-19 Health Declaration
All Pittsburgh Performance Project staff and cast members are required to complete the below declaration 1 hour prior to all sanctioned events (e.g. rehearsal, performances, competitions) in order to participate in the 2021-2022 season. Those who do not submit this declaration will be turned away, and subject to removal from the program.
Sign in to Google to save your progress. Learn more
Your Full Name *
Today's Date - NOT YOUR BIRTHDAY *
MM
/
DD
/
YYYY
Your Email Address *
Your Cell Phone Number (XXX-XXX-XXXX) *
Have you been fully vaccinated for COVID-19? *
Have you been diagnosed with COVID-19 within the last 14 days? *
If you answered yes to the above, were you hospitalized? *
Have you been in close contact with anyone exhibiting symptoms of COVID-19? *
Have you been asked to self-isolate or quarantine by a medical professional or public health official? *
Are you currently experiencing any of the following symptoms? *
Required
Have you traveled outside of the tri-state area (this includes international travel) within the last 14 days? *
COVID-19 LIABILITY WAIVER - Please read and acknowledge below:
Do you agree to the Liability Waiver presented above? *
Type your name below to confirm the information you have provided is truthful. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy