Stockton University COVID-19 Visitor Health Pledge & Parking Registration

Site

Please provide location that you are visiting

Visit date

Please provide the date you are visiting campus, format mm/dd/yyyy

Length of visit

Please select your length of today's campus visit

License plate of motor vehicle

Please provide the license plate of the vehicle you are bringing to campus

Number of visitors in your group

Please select the number of visitors for today's campus visit

Primary Visitor

First name

Please provide a first name for Primary Visitor

Last name

Please provide a last name for Primary Visitor

Email of primary visitor

Please provide your email address

Cell phone number of primary visitor

Please provide your cell phone number, do not include dashes

Visitor 2

First name

Please provide a first name for Visitor 2

Last name

Please provide a last name for Visitor 2

Visitor 3

First name

Please provide a first name for Visitor 3

Last name

Please provide a last name for Visitor 3

Visitor 4

First name

Please provide a first name for Visitor 4

Last name

Please provide a last name for Visitor 4

Visitor 5

First name

Please provide a first name for Visitor 5

Last name

Please provide a last name for Visitor 5

Visitor 6

First name

Please provide a first name for Visitor 6

Last name

Please provide a last name for Visitor 6

Reason for visit

Please provide your reason for today's campus visit

In order to be physically present on the Stockton University campus, I attest to the following:

All members of my party have not tested positive for COVID-19 in the past 14 days.
If any party member has previously tested positive for COVID-19, it has been at least 10 days after symptom onset and at least 24 hours after the resolution of any fever (without the use of fever-reducing medications), and they have been cleared by a medical provider.
If any party member has previously tested positive for COVID-19 but has not experienced any symptoms, they have quarantined for 10 days after the last positive test, and they have been cleared by a medical provider.
All members of my party have not been within 6 feet for 10 minutes or longer of a person that we are aware has tested positive for COVID-19 in the past 14 days.
All members of my party are not experiencing the following symptoms related to COVID-19: fever or chills; cough; shortness of breath or difficulty breathing; fatigue; muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; nausea or vomiting; diarrhea.
All members of my party are not under quarantine as directed by a healthcare provider, or subject to a Federal, State, or local quarantine order related to COVID-19.
All members of my party agree that we will not come to the Stockton University campus or affiliated locations (including sites such as internships, field placements, and service learning) for any reason if any of the above change.
All members of my party agree to abide by the Stockton University COVID-19 Plan.

I do not agree