COVID-19 Health Attestation for The Rivers School Conservatory

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In order to comply with state and local regulations, we need to have every family and every faculty or staff member certify that they are healthy before they can come to an event on campus. One form can be used per family unit. Please fill out this form and submit below.

Email *

Reason for coming to campus *

Full name of person filling out this form *

Email address of person filling out this form (named above) *

Phone number of person filling out this form (named above) *

Number of family members attending (including yourself) *

Full name of all family members attending *

I attest on behalf of our family unit, or as a faculty/staff volunteer, that we are not experiencing symptoms of cough, shortness of breath or difficulty breathing, fever, chills, muscle aches/pains, sore throat, headache, fatigue, new loss of taste or smell, gastrointestinal symptoms (nausea, vomiting, diarrhea), or a rash. We also have not been exposed to someone with confirmed or suspected COVID-19 in the past 14 days. *

Yes

A copy of your responses will be emailed to the address you provided.

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