Required

If you plan on visiting the inside of a building on our campus, please complete this form in its entirety prior to your campus visit. The form must be completed individually for each member in your party. Thank you so much! 

Must contain a date in M/D/YYYY format
Name of department you will be visiting:required
I am asymptomatic of any illness (cough, fever, sore throat, etc.)required
Is your temperature under 100 degrees?required

Have you:

In the past 24 hours: (Check all that apply)requiredPlease select up to 5 choices
Please select up to 5 choices
Are you fully vaccinated against Coved-19?required
Have you received a Covid-19 booster vaccination?required
Electronic Signaturerequired
By selecting yes for Electronic Signature; I am indicating my signature. I am also agreeing that the information above is true, and I will adhere to the Country Day visitor policy.