Healthy Harvest - Tulare County
Hotel Request Form
If you do not have an email address, please write firstname.lastname@example.org
Please list employers name and/or type of business.
Employer's Address (COUNTY ONLY)
Employer's Phone Number
Please confirm each statement:
I confirm that I work in California food processing or agriculture.
I confirm I have either tested positive for COVID-19 or have been exposed to COVID-19 as documented by a public health official or medical health professional.
I am unable to self-isolate at home.
Provider Name confirming exposure.
United Health Center
NOTE: You must have a letter from this provider confirming the statement above.
Free Hotel Transportation
Yes Please! - Arrangements will be made to transport you to and from the hotel.
No Thanks - I'll make my own way there
Address to be picked up for hotel transportation
Street Address Line 2
State / Province
Postal / Zip Code
Preferred Spoken Language
Please indicate which language you prefer in order to best communicate with you during this assistance.
Special Requests Needed
Should be Empty: