SLAC COVID-19 Check-In Form

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Please fill this out on the day you plan to come to SLAC, before each time you visit.

Email *

Full name you used to sign up for lesson/open *

Reason for Visit *

Are you currently experiencing any of the following new or worsening signs or symptoms of possible COVID-19? *

yes

Cough

Shortness of breath or difficulty breathing

Chills

Muscle pain

Headache

Sore throat

Loss of taste or smell

Diarrhea

Feeling feverish or a measured temperature greater than or equal to 99.6°F

If you answer “yes” to any of these questions, you will not be allowed entry into SLAC today. We recommend self-quarantine at home for 5 days.

Self-quarantine at home and contact your primary care physician’s office or nearest urgent care facility for direction.

• You should isolate at home for a minimum of 5 days since symptoms first appear.
• You must have 1 day without fever (without the use of fever-reducing medications) and improvement in respiratory symptoms before you come to SLAC.

(Resource: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html#anchor_1633109423704)

In the past 5 days, have you had close contact with an individual who has tested positive for COVID-19? *

Close contact is defined here: https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/appendix.html#contact

yes

If you answer “yes” to this question, you will not be allowed entry into SLAC today.

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