Store Entry Notification Form

Store Entry Notification Form
Please complete this form to notify your entry into the store and help us maintain a safe and secure environment.
Full Name
First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date and Time of Entry
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Purpose of Visit
Person or Department to Visit
Company/Organization (if applicable)
Have you experienced any of the following symptoms in the last 14 days? (Fever, cough, shortness of breath, loss of taste/smell, etc.)
Temperature at Entry (°F)
Checklist: Please confirm you are following store safety protocols
Signature
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