COVID-19 Health Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete on the day of rehearsal before you leave home.

Email *

First name *

Last name *

Have you been diagnosed with COVID-19 within the last 5 days? *

Yes

Have traveled out of the country in the last 14 days? If so please contact David Church concerning your COVID-19 testing in order to secure permission to attend the rehearsal. *

Yes

Are you currently experiencing any of these symptoms? Select the last option if none. *

Chills or fever (higher than 100.00 F or 37.7 C)

Shortness of breath

Cough

Loss of smell or taste

Sore throat

Headache, fatigue, or weakness

Diarrhea or abdominal pain

Rash

I have NONE of these symptoms.

Required

If you answered yes to question 1 or 2, or checked any symptoms, you should contact David Church and NOT attend the rehearsal.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms