I, nor anyone in my household have had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 100 degrees Fahrenheit.

I, nor anyone in my household have tested positive for COVID-19.

I have not traveled outside the U.S. in the past 21 days.

I to the best of my knowledge have not been in close proximity to any individual who tested positive for COVID-19.

I do not have any reason to believe myself or anyone in my household has been exposed to or acquired COVID-19.

I am following all CDC recommended guidelines as much as possible and limiting my exposure to the COVID-19.