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2021 June Merriman Hollow Workday Volunteer Registration and Waiver
This survey is for Merriman Hollow Maintenance Workday on Saturday, June 12 at 9am-noon.
Please wear a face mask if you are not fully vaccinated and bring gloves and a reusable water bottle to stay hydrated.
Please contact Jenny Petoskey (
petoskeyjennifer@gmail.com
) for any questions about the event.
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* Indicates required question
Email Address
*
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Daytime Phone Number (use format 313-123-4567)
*
Your answer
City
*
Your answer
Number attending
Choose
1
2
3
4
5
Please include the names and ages of any youth under the age of 18 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.
Your answer
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?
*
Yes
No
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?
*
Yes
No
3. Have you traveled via airplane in the last 14 days?
*
Yes
No
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?
*
Yes
No
I agree not to attend the event if any of the answers to questions 1-4 are yes. I also agree to ask myself the same four questions within 24 hours of the event and excuse myself if any answers have changed to yes.
*
Yes
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