SLAC COVID-19 Check-In Form
Please fill this out less than 12 hours before each time you come to SLAC.
Email address *
Full name you used to sign up for lesson/open *
Date of your visit *
MM
/
DD
/
YYYY
Reason for Visit
Are you currently experiencing any of the following new or worsening signs or symptoms of possible COVID-19? *
yes
no
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
In the past 14 days, have you: *
yes
no
Had close contact with an individual diagnosed with COVID-19?
Had close contact with an individual who is ill with a respiratory illness?
Traveled via flight internationally or domestically?
Traveled to an area that the World Heath Organization or CDC considers a "hotspot" (besides Missouri)? https://www.kff.org/coronavirus-covid-19/issue-brief/state-data-and-policy-actions-to-address-coronavirus/
Dined indoors at a restaurant?
Patronized an indoor bar?
Spent any social time unmasked indoors with people who aren't in your household?
If you answer “yes” to any of the symptoms listed above, or your temperature is higher than 99.6°F, you will not be allowed entry into SLAC today.

Self-isolate 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 7 days since symptoms first appear.
• You must also have 3 days without fevers and improvement in respiratory symptoms.
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 14 days.
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