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COVID Agreement

Self-Screening Form

THIS FORM MUST BE COMPLETED THE DAY OF THE SOS FUNCTION YOU ARE ATTENDING. ALL FUNCTIONS REQUIRE PRIOR RSVP. THANK YOU FOR YOUR COOPERATION.

Each participant is required to self-screen for COVID-19 symptoms before each SOS in-person function by responding to the questions below; this includes taking their own temperature and signing the acknowledgement at the bottom.

If you are experiencing any symptoms of COVID-19 including:

· Fever of greater than 100.4°F

· Dry cough

· Shortness of breath

· Chills

· Muscle aches / pain

· Sore throat

· Nausea/vomiting or Diarrhea

· Fatigue / malaise

· Recent inability to taste or smell

DO NOT ATTEND, isolate yourself from other family members, and call your medical provider.







Fri, October 30 2020 12 Cheshvan 5781