3 Stripe Life Registration Form

3 Stripe Life Registration Form
Student Name
First NameLast Name
Student ID Number
915-123-456
Student Email
example@student.savannahstate.edu
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
All students attending The Office of Student Life events are asked to confirm/verify the information requested below by selecting "I CONFIRM" in the space next to each question/statement. The Office of Student Life will maintain the completed form should there be a request from the university COVID- Taskforce.
I confirm that I am not presenting any of these COVID-19 symptoms: shortness of breath, coughing (wet or dry), sore throat, runny nose, and loss of taste or smell.
I confirm that I have not been in contact with anyone who has been diagnosed with COVID-19 within the past 14 days.
I verify that I have not traveled to countries or any areas of concern and contracted COVID-19 within the last 14 days.
Signature
Clear
Should be Empty: