COVIDWAIVER

Classes
- schedule
- descriptions
Programs
Events
Sports
Kids
- KidSpace
- Parties
COVIDWAIVER

DAILY COVID WAIVER

Please complete this form prior to coming to each workout

* Indicates required field

Name *

First

Last

Cell Phone Number *

Today's Date *

HAVE YOU (PARTICIPANT) BEEN ILL WITH A FEVER, CHILLS, COUGH OR BODY ACHES IN THE LAST 14 DAYS? *

Yes NO

HAS ANYONE IN YOUR HOUSEHOLD HAD THESE SYMPTOMS IN THE LAST 14 DAYS? *

Yes No

HAVE YOU OR ANYONE IN YOUR HOUSEHOLD TRAVELED INTERNATIONALLY IN THE LAST 14 DAYS? *

Yes No

HAVE YOU (PARTICIPANT) OR ANYONE IN YOUR HOUSEHOLD TRAVELED TO A LOCATION IN THE US WHERE AN INCREASE OF INCIDENCES OF COVID-19 HAS BEEN REPORTED IN THE LAST 14 DAYS? *

Yes No

HAVE YOU (PARTICIPANT) BEEN TOLD BY A HEALTHCARE PROVIDER THAT YOU SHOULD SELF-QUARANTINE DUE TO POTENTIAL COVID-19 EXPOSURE OR YOU ARE SUSPECTED OF HAVING COVID-19? *

Yes No

BY CHECKING THE BOX BELOW, YOU AGREE THAT YOUR STATEMENTS ARE ALL TRUE TO THE BEST OF YOUR KNOWLEDGE *

I AGREE

Submit

1440 Lower Ferry Rd.
Ewing, NJ 08618
(609) 883-2000

Monday-Friday: 5am - 9pm
Saturday: 7am - 5pm
Sunday: 7am - 5pm

Classes
- schedule
- descriptions
Programs
Events
Sports
Kids
- KidSpace
- Parties
COVIDWAIVER

DAILY COVID WAIVER

​Please complete this form prior to coming to each workout

Please complete this form prior to coming to each workout