Room to Grow Volunteer Waiver

 In order to ensure the health and safety of all members of the Room to Grow community, we are asking all visitors to our spaces to answer the following health screening questions.

Thank you for helping us keep the Room to Grow community a safe place for all! 

First Name

Last Name

Volunteer Location

Please select... New York Boston Another Location

COVID-19 Symptoms Screening

Are you currently experiencing any symptoms of illness including: fever of 100.4 degrees F or greater, cough/shortness of breath, or any other cold or flu-like symptoms?

YesNo 

Have you received a positive COVID-19 test result within the past 5 days

YesNo

Answered "yes" to any screening questions? (1 = yes, 0 = no) (HIDDEN)

Notification Email (HIDDEN)

Location Email (HIDDEN)

Specific Location (HIDDEN)