COVID-19 Sailor Affirmation

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This form must be filled out for each PLEON sailor every day they come to the club. It must be done THAT DAY PRIOR TO ARRIVAL.

Email *

PLEON Sailor's Name *

Is the sailor or anyone in their household experiencing any of the symptoms listed below? (Please consider your answers carefully and do not enter the PLEON premises if anyone in the household has any COVID symptoms. We need to keep each other safe.)

• Fever or experiencing chills/sweating/feeling flushed
• Sore throat
• New cough (not related to chronic condition)
• New nasal congestion or new runny nose (not related to seasonal allergies)
• New rash and/or inflammation
• Loss of taste and/or smell
• Shortness of breath
• Headaches
• Nausea, vomiting or diarrhea

I affirm to the best of my knowledge that neither my PLEON sailor nor anyone in our household is suffering from any of the symptoms listed above and that, to the best of my knowledge, my sailor has not been in contact with anyone diagnosed with COVID-19.the *

Yes, I affirm

Required

Your Name *

Please be sure your sailor arrives at PLEON with a face covering, PFD, water bottle and proper clothing for the weather conditions. Thank You!

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

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