Victoria & David Beckham Wedding

New York State requires us to keep records of all guests attending an event at The Somerley at Fox Hollow. Please enter your details below:

__*If the guest is a minor, an adult from their (party/household/family) in attendance must complete this form on their behalf.__

First Name

Last Name

Email Address

Phone Number

Date of Birth

Address

City

State / Province

Postal / Zip Code

COVID-19 Compliance Attestation Questions

Please complete and accept the following statements in order to participate as a guest at The Somerley at Fox Hollow

To ensure the health and safety of all participants in this event, I hereby attest that:

**I have not had a temperature of greater than 100.4°F (38°C) in the past 14 days.**

**I have not experienced symptoms of fever, chills, cough, difficulty breathing, fatigue, new loss of taste or smell, sore throat or any other symptoms related to COVID-19 within the last 14 days.**

**I have tested negative for COVID-19 and I will present proof of my negative result. OR I have completed the vaccination series and I will present proof of completion.**

**COVID-19 TESTING REQUIREMENTS**
Either 1) a PCR test that has been collected within 72 hours of the event start time; or 2) a Rapid test within 6 hours of the event start time.

**VACCINE SPECIFICATIONS:**
Attendee must have been FULLY vaccinated **more than 14 days** before the date of event.

**I have not been in close contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19.**

**I have not tested positive for COVID-19 in the past 14 days.**

**If I have traveled internationally, I have completed my mandatory quarantine.**

**I understand that I must comply with the following risk mitigation strategies:**
- Maintain a distance of at least 6 feet from other people whenever possible.
- Wear a face-covering whenever I am not seated.
- I will only dance (if applicable) with members of my table in the space designated to me. I will not enter other dance areas. I must wear a face-covering while in my dance area.

**By attending this event I assume all risks and will not hold The Somerley at Fox Hollow responsible.**

**Following the pronouncements above I hereby declare the following:**

I am fully and personally responsible for my own safety and actions while and during my participation and I recognize that I may be in any case at risk of contracting COVID-19.

With full knowledge of the risks involved, I hereby release, waive, discharge Fox Hollow, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.

I agree to indemnify, defend, and hold harmless Fox Hollow from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.

Signature

Forms will be kept for a minimum of 28 days following the event date and made available to State and local health authorities upon request.

Information on this form may be used for contact tracing.

Victoria & David Beckham Wedding

COVID-19 Guest Check-In