COVID-19 Questionnaire

Name: Fourth Friday Family Game Night at Mitchell Creek Marina
Start: 2020-08-28T18:00:00-05:00
End: 2020-08-28T21:00:00-05:00
Location: Mitchell Creek Marina

In order to keep our staff and patrons safe, we ask that you take a moment to complete the following questionnaire…

COVID-19 Questionnaire

Are you feeling unwell with symptoms such as fever, sore throat, cough or shortness of breath?*
- Yes
- No
Have you traveled overseas in the last 14 days?*
- Yes
- No
Have you had close contact (face-to-face contact for more than 15 minutes, or have shared an enclosed space for more than two hours) with someone who had a confirmed case of novel coronavirus (COVID-19)?*
- Yes
- No
Name*
First Last
Email*
Consent*
By submitting this questionnaire you are certifying that all of the information provided is true and correct

Mitchell Creek Marina, 1260 Livingston Boat Dock Road, Allons, TN 38541 | Reservations: 866.533.1842 | General Information: 931.823.6666