Proof of Covid-19 Booster Form

I understand and will comply with these guidelines:
1) Only fully COVID-vaccinated people with booster shots may attend in-person activities. This means you are two (2) weeks or more past your booster shot. Unvaccinated members are encouraged to participate in our online challenges and fitness classes. initials*   

2) Members must provide a legible copy of their vaccination record, showing their name, date of their booster dose, and the name of the vaccine they received. Upload your card above.   initials*   

3) All members, even long-time participants, must newly register for desired in-person program(s) by submitting this form. Once your membership form, medical release form, and vaccination status are verified, we will share your information with group leaders so you can receive activity information. Please expect that this may take a few days.   initials*   

4) Members agree not to forward activity information to anyone. If a friend (including a current or prior TSNW member) asks for information, please direct them to the website or to email programs@teamsurvivornw.org. Each person must individually complete this process to allow us to maintain a safe and predictable environment.   initials*   

5) Members may not bring guests to activities at any time, including family members, friends, etc.    initials*        

6) Do not attend any in-person activity if you or a household member is sick or has recently tested positive for COVID. All attendees must review symptoms the day before the activity and will sign an attestation form on the day of the activity.     initials*      
Attestation Questions:  

• In the last 14 days, has anyone in your household tested positive for COVID-19? 
• In the last 48 hours, have you or a household member had any of the following symptoms not caused by another condition? Fever, Cough unrelated to allergies, Shortness of breath or difficulty breathing, A decrease in the sense of smell or taste, Rash or discoloration of fingers/toes, Diarrhea, Sore throat, Muscle or body aches, Unusual Fatigue, Uncharacteristic Headaches, Nausea or vomiting.

7) Members are encouraged to report any safety concerns or complaints to the Program Manager as soon as possible so we can address it quickly. We care about the safety of every person in our organization.   initials*   

8) In the event that someone in a group tests positive for COVID, no in-person activities will be held for 10 days for the affected group(s). If someone is a close contact to someone with COVID, that individual cannot attend programs for 10 days.    initials*         

9) TSNW may not require masks outside since participants are vaccinated. However, do plan to bring a mask and be sensitive to those around you who may have a different risk and/or comfort level than you. Masks may be required in carpool situations or indoors at the discretion of the program leader in order to promote a safe and inclusive environment.     initials*     

10) TSNW procedures may change based on future announcements by public health authorities. We ask for your patience and flexibility if adjustments must be made on short notice.    initials*