Ramblers Spring 2021 COVID Attestation
Email address *
Enter today's date *
MM
/
DD
/
YYYY
Full Name *
Have you tested positive for COVID within the last 14 days? *
Have you been in close contact with anyone that has tested positive for COVID within the last 14 days? *
Are you experiencing any symptoms of COVID, including but not limited to coughing, sneezing, shortness of breath, sore throat, fever, and recent loss of taste or smell? *
Have you travelled to any high risk areas within the past 14 days? *
I acknowledge that if I answered YES to any of the above questions, I should not attend the Ramblers event so we can keep each other safe. *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of The New York Ramblers. Report Abuse