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22491 Foothill Blvd
Health Declaration

Before participating in activities onsite, you must submit this form each day you enter the premises. If you experience any symptoms of COVID-19 after being onsite, you must immediately notify our safety staff. Your information will be strictly confidential, as we evaluate for and possibly conduct contact tracing procedures.

02:30 PM
Have you tested positive for COVID-19 in the past 10 days?
Have you had close contact with anyone with COVID-19 in the past 10 days? Close contact is within 6 feet of a COVID positive person for at least 15 minutes, even if both people were wearing masks.
In the past 10 days, have you had any symptoms such as a fever of 100 F or higher, loss of taste or smell, difficulty breathing, sore throat, severe headache, vomiting or diarrhea?

Thanks for submitting!

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