The St. James - Self-Health Assessment Acknowledgement
PRE-VISIT HEALTH ASSESSMENT

"You" or "Customer" as used in this form means the person filling out this form.

The Pre-Visit Self-Health Assessment must be completed NO EARLIER THAN 12-hours before attending any TSJ function/activity. The St. James prohibits any participant from entering the building if their temperature is 100 degrees or higher OR answered YES to the questions listed below.

Additionally, you must have read and acknowledged the The St. James Terms & Conditions of Participation waiver. Participants that have not completed a The St. James Terms & Conditions of Participation Wavier will be prohibited from entering the building.

This Pre-Visit Self-Health Assessment is subject to the terms of The St. James Privacy Policy: https://www.thestjames.com/policies/privacy-policy.  You may opt out of communications from The St. James by notifying us in writing.
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Pre-visit Self Health Assessment
Before visiting The St. James, every visitor/participant should complete the following Self Health Assessment to determine whether they meet the criteria to participate. If you/your child answers "yes" to any of the questions below, please reconsider your visit until a period of fourteen (14) days has passed since your/their symptoms first appeared.

1. Have you had a new fever (100 degrees Fahrenheit  or higher) or sense of having a fever?

2. Have you had any respiratory symptoms, including a cough, shortness of breath, difficulty breathing or chest congestion that cannot be attributed to another health condition?

3. Have you had any cold or flu like symptoms, including chills, sore throat, congestion and/or fatigue that can not be attributed to another health condition?

4. Have you had any new muscle aches (myalgia) that cannot be attributed to another health condition or specific activity (such as physical exercise)?

5. Have you had a loss of taste or smell?

6. Have you had contact with someone in the past 14 days with suspected or confirmed COVID-19?
By checking “I Agree” below: (i) I acknowledge that checking this serves and has the same force as my signature; (ii) I acknowledge completion of the Pre-visit Self-Health Assessment and meet all criteria for entry; (iii) I acknowledge completion of THE ST. JAMES TERMS AND CONDITIONS OF PARCTICIPATION, which is executed by both parties; (iv) I acknowledge and agree to abide by the Terms and Conditions contained in these Agreements.
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