COVID-19 Health Screening Questionnaire

Please encourage everyone at your table to fill out this form.
Filling out this form will also enter you into the draw for the door prize.

Currently I am not experiencing:

  • A fever or above normal temperature?
  • Shortness of breath or trouble breathing?
  • A dry cough?
  • A runny nose?
  • Lost or had a reduction in your sense of smell?
  • A sore throat?
  • Been tested for COVID-19 and are awaiting results?