Brattleboro Ski Hill COVID Screening and Attestation

Please complete on the day of skiing or snowboarding. Please take temperature at home before coming to the hill.
Ski Hill Rules
- Masks or face coverings will be worn at all times, including spectators.
- As much as possible, physical distancing of at least 6 feet will be maintained.
- You may only ride the T-bar with another member of your household.
- No smoking anywhere on the ski hill.
- Anyone who is unable to follow these rules, will not be permitted to use the park.
Would you like to be contacted about volunteering? (optional)

YES, please send me an email about volunteering NO thanks I'd like to make a tax deductible donation. Please send me an email with a paypal link.
First and Last Name:
Contact Phone
Street Address, Town and State
Email
example@example.com
Have you been in close contact with a person who has COVID-19 in the past 14 days? *

YES NO
Have you been directed by the Department of Health to quarantine? *

YES NO
Are you visiting Vermont, or have you traveled outside of Vermont in the last 14 days for any non-essential purpose? *

YES NO
For questions about traveling to Vermont for leisure: https://accd.vermont.gov/covid-19/restart/cross-state-travel/faqs#can-i-travel-to-and-from-vermont-for-leisure-travel

Information for Vermonters traveling out of state https://www.healthvermont.gov/covid-19/travel-quarantine/vermonters-traveling-out-state
Have you complied with Agency of Commerce and Community Development (ACCD) and Department of Health guidance around quarantine? *

YES NO
Do you feel unwell with any symptoms consistent with COVID-19? For example, have you had fever (100.4), cough, shortness of breath or difficulty breathing, chills, repeated shaking with chills, fatigue, muscle or body aches, headache, congestion or runny nose, sore throat, new loss of taste or smell, nausea or vomiting, diarrhea? *

YES (must consult with medical provider) NO
By signing below, you acknowledge understanding of associated risks, waive the Town of Brattleboro and LMPSS, Inc of liability, and attest to the information provided.
Today's Date (You may only complete this form on the day you will be skiing or snowboarding) *

Month Day Year
Date
Signature

Clear
Should be Empty:

Please complete on the day of skiing or snowboarding. Please take temperature at home before coming to the hill.