Covid-19 Wellness Form

Dear Friends,

We look forward to your visit at the Holy Trinity Center or the Hampton Event Center. Please complete today's screening for you, your family, and/or everyone in your vehicle/party. Upon completion of the screening, you will receive a confirmation screen to save. Please take a screenshot of the confirmation screen (or otherwise save or print it) and show it to the attendant upon arrival.

If you are unable to complete the screening or have health concerns, please contact: 724-444-6770 or info@hamptonbanquethall.com.

Screening Questions

Have you been fully vaccinated against COVID-19?

1. On behalf of myself and everyone with me in my vehicle/party, we understand an inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. By visiting our locations, we voluntarily assume all risks related to exposure to COVID-19

2. Have you (and those with you) experienced any of the following COVID-19-related symptoms in the last 24 hours: Fever, 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?

3. Have you had any known exposure to someone with or suspected to have COVID-19 in the last 14 days?

4. All information on this screening is true and correct to the best of our knowledge.

5. We are aware of the signs and symptoms of COVID-19 as outlined by the CDC here.

6. We are aware of how to protect ourselves and others as outlined by the CDC here.

7. We acknowledge that Hampton Banquet Hall Inc. will retain information of this screening as record of our entry. This information may be shared with third party advisors if deemed appropriate by Hampton Banquet Hall Inc.

Covid-19 Wellness Form

Event Information

Group Information

Screening Questions

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