Pre- Panther Day July 23rd

First Name

Last Name

Email Address

Birthdate

How many guests will be joining you?

Do you or a family member require any physical assistance (ei. wheelchair accessibility)? Please provide details, as you feel comfortable.

Yes

No

Do you have any other specific questions, comments, or concerns you would like us to be aware of? If so please outline them below.

COVID-19 Health Screening

In an effort to reduce the risk of COVID-19 exposure to Greenville University employees, all visitors must complete the following screening questions:

Have you traveled out of the United States or recently traveled to an area in which community spread or ongoing spread of COVID-19 is present? *

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

Have you experienced any cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath, or other respiratory problems)? *

Greenville University is requiring all employees, students, guests and visitors to adhere to the guidelines and recommendations set forth by the CDC, IDPH and Bond County Health Department in practicing social distancing guidelines, healthy hand washing practices and the use of face coverings when social distancing guidelines cannot be met. Do you understand and agree to follow the required guidelines as outlined? *

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Pre- Panther Day July 23rd