Statement of Health

Please read and 'sign' the following certification statement prior to the start of your service:

I, , have not been quarantined within the last 14 days due to COVID-19 symptoms or illness, and I am not showing symptoms today. Additionally,





Electronic Signature - type your full name in ALL CAPS (required)

Date (required)

Your Email Address (required)

Your Phone Number (required)

This form will be emailed to the front desk.