Guest Check-In Clearance Form

Guest Check-In Clearance Form

In accordance with the LACM Vaccination Policy, proof of vaccination is required to be on the LACM Campus.

All those who check-in to enter campus will also be screened for COVID-19 symptoms, and will be notified if they are not cleared for entry.

No visitor will be given access to the LACM campus until this form is completed.

Thank you for your cooperation in helping us to keep our community safe!

Name*

First Name

Last Name

Email*

Phone*

Have you previously submitted your proof of vaccination to LACM?*

Yes, I've submitted proof of vaccination No, I have not submitted proof of vaccination I'm not fully vaccinated and understand that I am required to wear a mask while in the building

Be prepared to show proof of Vaccination at check-in if you choose Yes. Unvaccinated guests are required to wear a mask.

Please Upload your Vaccination Card Here (optional)

No File Chosen

File uploads may not work on some mobile devices.

Please upload proof of your Negative Test here (optional)

No File Chosen

File uploads may not work on some mobile devices.

How are you feeling today?*

No symptoms I am not coming to campus today I've tested positive for COVID-19 I have been in close contact with someone who tested positive for COVID-19 2 or more of the following symptoms (Fever, New Cough, Shortness of Breath, New Loss of Taste or Smell, Sore Throat, Congestion or Runny Nose (Except Seasonal Allergies), Diarrhea, Muscle or Body Ache, Nausea or Vomiting, New Headache, New Unexplained Fatigue) apply to me:

Please choose the statement that most accurately matches how you were exposed to COVID-19*

Loss of Smell or Taste, Temperature over 100.4 degrees F or chills. Close contact with someone who tested Positive without a mask. I've been in close contact with someone who tested Positive for COVID-19 and I WAS wearing a mask. I've been in close contact with someone who tested Positive for COVID-19 and I was NOT wearing a mask.

E-Signature*

I understand and will comply with all safety guidelines and protocols at all times

Covid-19 Vaccination Required*

I acknowledge and understand that each of my guests and myself must provide proof of a Covid-19 Vaccination along with a valid ID upon arrival to LACM's campus.

Signature*

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Use your mouse or finger to draw your signature above