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*
Have you previously submitted your proof of vaccination to LACM?*
Be prepared to show proof of Vaccination at check-in if you choose Yes
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How are you feeling today?*
Please select two or more symptoms that apply to you today*
Please choose the statement that most accurately matches how you were exposed to COVID-19*
E-Signature*
Covid-19 Vaccination Required*
Use your mouse or finger to draw your signature above
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