Volunteer Check-in & Waiver Form Please complete this information on the date you volunteer:URL URL Today's Date *Name *Phone *Email *Please answer each question:Have you (or children brought with you) experienced any of the following symptoms in the past 48 hours? (Check all that apply.) *Fever or ChillsCoughShortness of BreathUnusual FatigueMuscle or Body AchesHeadacheNew Loss of Taste or SmellSore ThroatCongestion or Runny NoseNausea or VomitingDiarrheaI HAVE EXPERIENCED NONE OF THE ABOVE SYMPTOMSWithin the past 14 days, have you or your child(ren) been in close physical contact (6 feet or closer for at least 15 minutes) with anyone who has a confirmed diagnosis for COVID-19? *YesNoWithin the past 14 days, have you or your child(ren) been in close physical contact with any person who is known to have any symptoms consistent with COVID-19? *YesNoAre you or your child(ren) isolating or quarantining because you may have been exposed to a person with COVID-19 or worried that you may be sick with COVID-19? *YesNoAre you or anyone in your household currently waiting on the results of a COVID-19 test? *YesNo What is your job?:What is your job?:
