Indian Mountain School Vendor/Partner/Guest Questionnaire

Effective Monday, March 16, IMS closed campus to all students and nonessential employees until April 13, at the earliest. In light of the rapidly evolving health crisis, and in accordance with health experts, the CDC, and local government officials, we will be requiring all essential campus visitors to complete this form to indicate where they have traveled within the United States and abroad.

Thank you for your support.

Your Contact Information

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* 1. First and Last Name

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* 2. Company

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* 3. Reason for Visiting Campus

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* 4. Phone Number

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* 5. Email Address

Travel Information

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* 6. Have you traveled outside of the U.S. in the past 14 days?

Yes (please list countries below)

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* 7. If you answered yes, when did you return?

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* 8. Have you traveled to any other states within the U.S. in the last 14 days?

Yes (please list states below)

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* 9. If you answered yes, when did you return?

Health Information

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* 10. Have you been in contact with a laboratory confirmed patient with COVID-19?

Yes

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* 11. Have you been in contact with anyone suspected of having COVID-19 or with cold/flu-like symptoms?

Yes

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* 12. Have you experienced any cold/flu-like symptoms in the last 14 days?

Yes