COVID-19 Certification Questionnaire

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The Desert Of New York is mandated and required by the CDC, New York State Law, The State Health Department, and the A.E.A.O.N.M.S., Inc. to adhere to COVID-19 regulations and practices.

Completing this form certifies that you are aware of the regulations and agree to them.

We will only use your information if we need to contact you.

Email *

Full Name *

Mobile Telephone Number *

Please enter your mobile telephone number. Please only enter the numbers.

I certify that I have not experienced any symptoms of the Coronavirus/COVID-19 (example; fever, new loss of taste or smell), in the last 48 hours. *

True

False

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