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Health Screening
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Name
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First
Last
Have you or anyone in your group been sick with a respiratory illness, flu-like symptoms, or COVID-19 in the last 3 weeks?
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Yes
No
Have you or anyone in your group been in contact with or close proximity (less than 6 feet) to any person sick with a respiratory illness, flu-like symptoms, or COVID-19 in the last 3 weeks?
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Yes
No
Are you currently under isolation or quarantine orders?
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Yes
No
Do you and everyone in your group adhere to the following safety requirements to enter CHF: Temperature check, wear face coverings (and gloves, if applicable), and abide by social distancing requirements?
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Yes
No
Signature
*
Clear Signature
You are signing for yourself and/or minors in your care specified in the Hold Harmless & Release Agreement.
Submit
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