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SHSCCheckInOut2020

Name *

Check In / Out *

Are you bringing a guest to the facility today? *

Yes

If yes, please provide the name of Guest 1

If yes, please provide the name of Guest 2

Are you a non-member using the facility as a caregiver for children that are members? *

Yes

No (I am a member)

If yes, please provide your full name

Have you traveled out of state since June 1, 2020? *

Yes

If yes, please list all U.S. states you have been to during that time.

COVID-19 Declaration *

I declare that neither I nor my family have any fever or symptoms of the virus.

If you are human, leave this field blank.