GMT COVID-19 Health Questionaire (MBBD122921)

Health Questionnaire

The safety of our employees, supplier partners, customers, families and guests remain our overriding priority. As COVID-19 pandemic continues to evolve across the globe, we are monitoring the situation closely and will periodically update company guidance based on current recommendations from the Centers for Disease Control and Prevention and local health and government officials. In order to participate in our trips, all guests must complete this Questionnaire.

Please complete one form per traveler.

Traveler Name*

First NameMiddle NameLast Name

Trip Name*

Personal Phone Number (Mobile/Home)

Area CodePhone Number

Grueninger Music Tours is not currently requiring a COVID-19 vaccine to travel on our trips. However, some of our vendors are requiring a vaccine. Should your trip have a vaccine requirement, we will notify you. Have you been fully vaccinated against COVID-19?*

Have you traveled outside of the United States within the last 14 days? *

Have you been in close contact with anyone who has traveled outside of the United States within the last 14 days?*

Have you been diagnosed with COVID-19 within the last 30 days?*

Have you experienced any of the following symptoms in the last 14 days (including fever, cough, sore throat, lost of taste or smell, difficulty breathing, unusual headaches, unusual fatigue, etc.)?*

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?*

If the answer is “yes” to any of the questions, please provide additional detailed information below

I agree to the following:*

Face Covering: Per the current CDC guidelines, I will wear a face covering when I am on the motorcoach, airplane, and/or train regardless of my vaccination status. Grueninger Music Tours strongly recommends wearing a mask at indoor venues per the CDC guidelines. When participating in group activities and when I am on my own, I will follow the local health and government guidance for the destination that I am visiting.Hand-Washing: I will wash my hands before eating food, and after touching publicly used surfaces. When hand washing isn’t possible, I will use hand sanitizer as an alternative.Temperature Check: I will allow for my temperature to be taken if a venue or Grueninger Music Tours requires it.Self-isolation: I will isolate myself from the group if I start feeling ill or have a fever, dry cough or other COVID-19 related symptomsMedical Assessment: I will seek medical attention to be assessed for COVID-19 if I have a fever or dry cough or other COVID-19 related symptoms and will not re-join the group until I have been given a negative diagnosis. Any costs incurred as a result of isolation or alternate travel plans will by my financial responsibility.I acknowledge and understand that, if I do not comply with the above commitments, I must leave the group and no longer participate in the trip. In this instance, no refund will be provided for missed activities.

Today's Date*

Date

Please sign*

Grueninger Music Tours

9011 North Meridian Street, Suite 100
Indianapolis, IN 46260-5378

(317) 581-1122 or (800) 225-9919, Fax (317) 479-1000

info@gogmt.com