MHC COVID-19 Waiver

Date of Birth:
Have you had or been in direct contact with someone who has had any symptoms consistent with Covid-19 such as fever, new loss of taste or smell, cough, or shortness of breath that are not associated with seasonal allergies, in the last 14 days?

Have you been in direct contact with anyone who has tested positive for Covid-19 within the last 14 days?
by clicking this box i certify this information is true to the best of my knowledge:

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