Waiver Signed for

To keep our staff, employees and customers at this locaton safe during the COVID-19 pandemic, we require anyone entering this lcoation to answer to the following questions. 

 

   I have answered these questions honestly and to the best of my ability.

If you answered yes to any of these questions, please provide details in the notes box below your name and notify our staff. 

 

I am parent or guardian signing for a minor.

Employee's INFORMATION

MINOR
MINOR
MINOR
MINOR
MINOR
MINOR
MINOR
MINOR
MINOR

Use your finger or stylus to
sign your name inside box

Clear and try again

USE YOUR FINGER OR STYLUS
TO INITIAL INSIDE BOX

Clear and try again