Health Check

Name

Email

Event Date

Event Time

Do you currently have a fever of 100.4 degrees F or great?

Do you have a cough or shortness of breath that began within the past 14 days?

n the past 14 days, have you received a positive result from a COVID-19 test?

n the past 14 days, have you been in contact with anyone testing positive for COVID 19?

Discount

Subtotal

Tax

Total USD

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