Common Contracts
1 similar Health and Safety Agreement contracts
Metigoshe Ministries Youth Retreat Registration and Health and Safety AgreementHealth and Safety Agreement • January 19th, 2021
YOUTH INFORMATION (ONE FORM FOR EACH PERSON ATTENDING) First and Last Name Name of Youth Retreat Attending 1. I have not been around anyone with any of the listed symptoms or diagnosis of COVID19 in the 14 days before the start of retreat. Initial Mailing Address City, State, Zip Best Phone Number to Reach You Date of Birth PARENT/GUARDIAN AND EMERGENCY CONTACT INFO 2. No one in our household has been sick in the 14 days prior to retreat. Initial 3. I have not traveled by air or traveled out of state in the 14 days prior to retreat.Initial Parent/Guardian(s) First and Last Name(s)Complete only if under 18 Mailing Address City, State, Zip 4. I have adhered to our state’s guidelines regarding COVID19. Initial Home Phone Cell Phone E-mail Address Emergency Contact Name if Parent/Guardian unavailable Phone of Emergency Contact HEALTH HISTORY AND MEDICAL INFORMATION Allergies: Food/Medications/Insects/Other Dietary Concerns/Restrictions Other Health Issues HE
