In Memory Of Garden Workshop  #3 Registration
This form is for those attending the In Memory of Garden- Planting Workshop on Thursday, September 10 at 6528 Minock St, Detroit, MI 48228
Face masks are required to be worn at the workshop. Please bring a reusable water bottle to stay hydrated.
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First Name *
Last Name *
Address
E-mail Address
Phone Number (Please use this format: 313-123-4567) *
FOTR COVID-19 Prescreening Health Survey
The purpose of this form is to pre-screen participants for COVID-19. It is a required part of registration for every individual for every event and also must be repeated 24 hours prior to the event. For adults signing up children who are too young to complete this form on their own, please add their names in the section after your phone number and include their response as part of your answers to questions 1-4.
Please include the names and ages of any children too young to fill out this form on their own that you would like to register. By adding them here, you agree to include their answers as part of your responses to questions 1-4.
1. Are you currently suffering from any of the following symptoms – fever, cough, shortness of breath, sore throat, new loss of smell or taste, and/or gastrointestinal problems, including nausea, diarrhea, and vomiting? (If so immediately take your own temperature.) *
2. Have you lived with, or had close contact with, someone in the last 14 days diagnosed with or displaying the symptoms of COVID-19? *
3. Have you traveled via airplane in the last 14 days? *
4. Has anyone you live with, or consider part of your “household” taken the COVID-19 test and not yet received results in the last 14 days? *
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