Face Covering Policy Acknowledgment Waiver Form
Face Covering Policy Acknowledgment Waiver Form. Please review, acknowledge, and sign below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization or Affiliation
Date of Visit or Event
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you read and understood the Face Covering Policy?
*
Yes, I have read and understood the policy.
No, I have not read the policy.
Please acknowledge that you agree to follow the Face Covering Policy while on premises.
*
I acknowledge and agree
I do not agree
Waiver of Liability: I understand and accept that failure to comply with the Face Covering Policy may result in denied entry or removal from the premises.
*
I understand and accept
I do not accept
Additional Comments (optional)
Signature
*
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: