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Friday Nite Youth Event - 2021
Full Name
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Email Address
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Phone Number (no symbols. Example - 6465555555)
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Date of Event
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Friday, June 11 2021 @ 6:30pm
1) Have you or any of the people attending with you, experienced any symptoms of COVID-19, including a fever of 99.5 degrees or higher, coughing, loss of taste or smell, or shortness of breath within the past 14 days?
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Yes
No
2) In the past 14 days, have you or any of the people attending with you, tested positive for COVID-19 from a certified test facility, clinic, or hospital?
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Yes
No
3) To the best of your knowledge, in the past 14 days, have you and those attending with you, been in close contact (within 6 feet for at least 10 minutes) with anyone who tested positive for COVID-19 or who has or had symptoms of COVID-19?
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Yes
No
4) Have you or any of the people attending with you, traveled internationally (including cruises) or from a state with widespread community transmission of COVID-19 as per the New York State Travel Advisory (
Click here
) in the past 14 days?
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Yes
No