COVID-19 Health Self Assessment QuestionnaireCOVID-19 Health Assessment QuestionnaireThank you for taking a moment to answer our questions. This information will help us to keep everyone as safe and healthy as possible. We reserve the right to ask you to postpone your visit if we feel your circumstances pose a health risk. Email * Name * Do you have now, or have you had in the past 2 weeks, any of the following symptoms? Fever, Shortness of Breath, Cough, Chills, Muscle Pain, Headache, Sore Throat. (If so, please explain) * Have you had contact with anyone who has been diagnosed with or has had symptoms of COVID-19? (If so, please explain) * Have you been contacted by a health official telling you that you may have been exposed to the virus and need to be tested? (If so, please explain) Where would you be traveling from to come to Easton Mountain? * Have you traveled anywhere else in the past month? If so, where? * Tell us a little about your isolation/contact circumstances over the past 1-2 months: (Examples: "I have been working from home and have had little contact with the outside world", "I have been going to work at a grocery store", "I have been mostly isolated but visit family weekly", "I work at a doctor’s office screening patients", etc.) * By checking here, I agree that If anything changes concerning the above statements, I will notify the Men's Knitting Retreats (contact@mensknittingretreat.com) I agree Please e-mail me a copy of my responses reCAPTCHA SubmitΔ
