Traveler Affidavit Form
County has enacted new travel orders to protect our community. All travelers must complete the online Traveler Affidavit prior to arrival.
Contact Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country Before Arrival
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Travel & Accommodation Information
Arrival Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Departure Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How will you arrive?
Car
Airplane
Bus
Other
Flight Number
Ticket Number
Vehicle License Plate
Are you a resident (full-time, part-time or second homeowner)of this County?
Yes
No
Is the accommodation you are staying at a private residence?
Yes
No
Address of Residence
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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COVID-19 Test and Quarantine Status
I certify that at least ONE of the following is true:
I have received a negative viral test result for COVID-19 on a specimen taken no longer than 72 hours prior to my arrival, consistent with CDC Domestic Travel Guidance.
I plan to get a test at my own expense and will remain in quarantine until I receive a negative result.
I have taken a COVID-19 test and am awaiting my result and will remain in quarantine once arriving in the County until I receive a negative result.
I will quarantine for 10 days upon arrival in the County or for the duration of my stay if fewer than 10 days.
I have received a positive RT-PCR or Antigen test result for COVID-19 within 90 days prior to the date of my departure and I have completed my 10 day isolation requirement.
By checking all the options, I certify:
I do not currently have COVID-19 symptoms
IÂ have not had close contact with anyone in the last 14 days who is confirmed or suspected to have COVID-19
IÂ will wear a mask while in public, as required by local law
IÂ will maintain 6 feet of physical distance from others
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Dependents Information
Are you traveling with dependent family members under the age of 18 (child(ren) or another person in your legal custody)?
Yes
No
Dependent Information
I certify that all dependents traveling with me meet the following:
Do NOT have COVID-19 symptoms.
Have NOT been in close contact with a COVID-19 positive individual.
Those over the age of 10 have also tested negative within 72 hours of arrival or agree to quarantine.
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Consent to Precautionary Measures
I herby certify that I, along with any dependents I am traveling with, will adhere to the 5 Commitments of Containment, which include:
Maintaining 6 feet of distance from anyone not in the household
Washing hands often
Covering face in public
Staying home when sick
Seeking testing immediately and self-reporting if experience symptoms.
I understand that it is my responsibility to know and follow all applicable local and state mask requirements, and certify that I will adhere to these requirements.
Agree
Disagree
I certify that I have reviewed and will adhere to the current quarantine and isolation requirements set forth by the County.
Agree
Disagree
Personal gatherings are not permitted. This includes in all private residences, even if gathering is masked and socially distanced. Only congregate with your own household. This applies to all lodging reservations and accommodations. I have reviewed the current requirements on personal gatherings and attest that I will adhere to these requirements throughout my stay in the County.
Agree
Disagree
By submitting this form, I hereby attest, under penalty of law, that all the information I have provided is true and accurate to the best of my knowledge.
Agree
Disagree
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: