COVID-19 Health Attestation for The Rivers School Conservatory
In order to comply with state and local regulations, we need to have every family and every faculty or staff member certify that they are healthy before they can come to an event on campus. One form can be used per family unit. Please fill out this form and submit below.
* Required
Email address
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Your email
Reason for coming to campus
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Your answer
Full name of person filling out this form
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Your answer
Email address of person filling out this form (named above)
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Your answer
Phone number of person filling out this form (named above)
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Your answer
Number of family members attending (including yourself)
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Your answer
Full name of all family members attending
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Your answer
I attest on behalf of our family unit, or as a faculty/staff volunteer, that we are not experiencing symptoms of cough, shortness of breath or difficulty breathing, fever, chills, muscle aches/pains, sore throat, headache, fatigue, new loss of taste or smell, gastrointestinal symptoms (nausea, vomiting, diarrhea), or a rash. We also have not been exposed to someone with confirmed or suspected COVID-19 in the past 14 days.
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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