PLL Spring 2021 -- Online Check-in
Participant's First Name
Papticipant's Last Name
Has the participant or a family member exhibited any of the following symptoms in the last week: fever or chills, cough, difficulty breathing, shortness of breath, sore throat, muscle or body aches, vomiting or diarrhea, loss of taste or smell? See
for more information
In the past 14 days, has the participant or a family member been diagnosed with COVID-19 or been in contact with someone who has been diagnosed with COVID-19?
Has the participant or a family member traveled to a location on the NJ Travel Advisory list within the last 14 days? Please see
for a current list.
I hereby certify that the above statements are true and correct to the best of my knowledge.
Sign with finger or cursor below: