FMTC Covid-19 Guest Health Attestation
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FMTC Covid-19 Guest Health Attestation
In consideration of being permitted to participate in activities as a guest at Fox Meadow Tennis Club, I attest that:

1. I have not tested positive or presumptively positive with Covid-19 or been identified as a potential carrier of the Covid-19 virus in the last 14 days.

2. I have self-monitored for symptoms of Covid-19 and have shown no symptoms.

3. I am not currently experiencing (nor have I in the past 14 days) a fever (temperature of 100.4℉ or greater) or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea and/or any other sign of illness.

4. I have not taken any fever-reducing medication in the last 24 hours.

5. I do not live with anyone with a suspected or confirmed case of Covid-19, or I do but I confirm that I am fully vaccinated.

6. I have not been in close contact with anyone diagnosed with Covid-19 within the last 14 days, or I have but I confirm that I am fully vaccinated.

7. I am following CDC and NY State Covid-19 guidelines.

8. I will comply with Fox Meadow Tennis Club's health and safety guidelines including, but not limited to, practicing social distancing and wearing a mask where required or encouraged.

Date *
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YYYY
Full Name *
Phone Number *
Email *
I am visiting FMTC for a league match *
Required
I am visiting FMTC as a guest of a member *
Required
I am visiting FMTC to take a lesson with a Pro *
Required
I am fully vaccinated *
If I answer No or Decline to answer, I agree to follow FMTC's rules for unvaccinated individuals.
Please write the name of the club you represent for interclub match , the member's name you are a guest of, or the name of the FMTC pro giving you a lesson.   *
I agree to the above terms. *
By clicking the yes box you confirm that all representations above are true.
Required
Signature *
By typing my name, I confirm that all representations above are true.
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