Date Date Format: MM slash DD slash YYYY Entry Time : HH MM AM PM Name First Last Name(s) of any additional people in your groupPhoneEmail Consent* Verify Lack of Known COVID19 SymptomsBy signing this, I verify that I do not/am not currently experiencing any of the following symptoms and do not know to be sick: Fever Chills Cough Shortness of Breath Fatigue Muscle/Body Aches Headache New loss of taste or smell Sore throat Congestion/runny nose Nausea/Vomiting Diarrhea Been in contact with a COVID+ person in the last 14 days Traveled to an area of high COVID cases in the last 14 days Traveled from outside MA or returned to MA in the last 14 days from a state other than the following: Hawaii (as of 11.30.20) Please initial to acknowledge your consent.*
