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Event Attendee Health Screening

Please complete the information below in compliance with attending your National MS Society event.

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I certify:
  • I am NOT currently (nor have I been in close contact with anyone who is) experiencing a cough, fever, sore throat, loss of taste or smell, nasal congestion, shortness of breath, unexplained headache.
  • I have NOT experienced body aches or pains, or diarrhea in the past 10 days, or otherwise felt unwell in the past 24 hours.
  • I have NOT experienced a fever of 100.4 degrees or higher in the last 24 hours.
  • I have NOT (nor has any member of my household) tested positive for a COVID-19 (the Coronavirus) in the past 10 days.
  • I have NO reason to believe I have been exposed to COVID-19.
  • I am NOT currently subject to an isolation or quarantine order.
  • I understand the contagious nature of COVID-19 and I assume all risk associated with attending this event, including being exposed to COVID-19, and I waive the National Multiple Sclerosis Society from all liability therewith.
© 2020 The National Multiple Sclerosis Society is a tax exempt 501(c)3 nonprofit organization. Its Identification Number (EIN) is 13-5661935.