COVID-19 Pledge Form

I,   First Name   Last Name   , of   City,   State, in recognizing the burden brought by the COVID-19 pandemic that affected the economy, society, and the government globally, and considering that the majority of these infections are treatable and avoidable, express my full support against the spread of COVID-19.

I understand the inherent risk of engaging in in-person activities during a pandemic. For this reason, I have committed to take part in securing the health and safety of my family and the entire community.

As a member of the community, it shall be my duty to do the following:

1. To continue supporting governmental programs in the safeguard and prevention of the spread of the COVID-19 such as wearing masks, practicing social/physical distancing, properly washing hands regularly, and monitoring my family's health regularly;
2. To voluntarily Isolate me from the public in case symptoms of COVID-19 arises in the household or in case I or members of my family household gets exposed to, or have been in close contact with a person infected with COVID-19;
3. To comply with the necessary health screenings for me and my family including temperature checking, upon arrival at the venue and recording my arrival and departure dates if necessary.
4. To cooperate with authorities and representatives for inquiries regarding contact tracing, and responding to questions with full honesty.
5. To notify health authorities in case I or my family members test positive for COVID-19;
6. To comply with recommended immunizations by authorities;
7. Help with educating others on the importance of the protocols specified above.

I understand the critical importance of taking responsibility for keeping our community safe. This commitment of support is a shared responsibility in ensuring the protection and well-being of each and every individual in the community.

I also understand that this is a collective effort that needs the full commitment of each and every individual for success in reducing, if not eliminating COVID-19 in the community and to reach our goal of making safe the environment for everyone.
 
By drawing my signature below, I understand and comply with the declarations and pledge above-mentioned.

Signature   
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Email   
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