Health declaraTion form

As the safety and health of our community is our main concern, we ask that you are honest in your declarations and we thank you for the support.

TERMS

I hereby certify, represent and warrant as follows:

Within the fourteen (14) days immediately preceding the date of this Health Declaration Form, I HAVE NOT:

 a. Tested positive or presumptively positive with COVID-19 or been identified as a potential carrier of COVID-19 or similar communicable illness

b. Experienced any symptoms commonly associated with COVID-19

c. Been to a state marked “unsafe for travel” and returned to MA without providing a negative test result or quarantining for 14 days per the MA State order for Travel & Tourism.

d. Been in direct contact with or the immediate vicinity of any person I knew and/or now know to be carrying COVID-19 or has travelled outside of the marked safe states within the last fourteen (14) days 

By completing the form below and pressing “submit,” you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.

Please complete the form below