2021 National Sporting Library & Museum Polo Classic
Presented by MARS EQUESTRIAN™
COVID-19 Waiver Form
and Proof of Vaccination
CONTACT INFORMATION
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Ticket Host/Vendor Name
COVID-19 WAIVER
I hereby certify that I have been fully vaccinated against COVID-19. I understand that the information provided herein will be used to facilitate contact tracing should it become necessary.
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Yes
I hereby agree to abide by event precautions put in place by the National Sporting Library & Museum (NSLM) at Great Meadow, based on state, local, or federal guidance.
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Yes
Please upload proof of vaccination (photo/copy/pdf of vaccination record).
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of
I hereby certify that should I or my child/children come into contact with anyone who has tested positive for COVID-19 within 10 days of September 12, 2021, I/we will not attend the event. I also certify that should I or my child/children display a fever or symptoms of COVID-19, I/we will not attend the event.
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Yes
If I am the parent or legal guardian of a participating minor: I hereby certify that my child/children is/are either vaccinated against COVID-19, or I will provide proof of their negative PCR test taken within 72 hours of the event to info@nationalsporting.org.
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Yes
Not Applicable
Please note that vaccination/PCR status will be confirmed at the gate. The National Sporting Library & Museum will comply with state and local recommendations regarding use of face coverings/masks. The NSLM will enforce social distancing requirements throughout Great Meadow in accordance with state, local, or federal recommendations.
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