COVID-19 Waiver

Statement of Symptoms, Quarantine, and Mask Agreement

Pursuant to the Governor of New Hampshire’s Emergency Order 27, all registered guests must
attest that they are not exhibiting any symptoms of COVID-19. Additionally, registered guests
checking in must provide a New England driver’s license as proof of residency. For non-New
England guests, they must attest that they have quarantined at home for 14 days or for 7 days
and then tested and received a negative diagnosis for COVID-19. Approved COVID-19 tests are
PCR-based (molecular) tests. Guests cannot have traveled by public transportation.

Symptoms Statement (Required by all guests):

By signing this statement, I attest that no one in my party is currently exhibiting any symptoms of COVID-19 such as:

  1. Have been in close contact with a confirmed case of COVID-19 (NOTE: Healthcare workers caring for COVID-19 patients while wearing appropriate personal protective equipment should answer “no” to this question.)
  2. Fever in the last 48 hours
  3. Respiratory symptoms such as sore throat, cough, or shortness of breath
  4. Changes in a person’s sense of taste or smell

 

Name: ________________________________

 

Signed: ________________________________ Date: ______________

 

Quarantine Statement required for guest who are not New England (New Hampshire, Maine, Massachusetts, Vermont, Rhode Island, and Connecticut) residents:

By signing this statement, I attest that I and all of the individuals staying with me in my rented room have been quarantined** at home for the past 14 days.

**The definition of quarantine in this instance means that the person or people registering to stay at this lodging facility have remained isolated at home for the past 14 days, going into the community only for necessities. In addition, when outside of the home, I/we have maintained social distancing and worn a face covering when less than six feet from another person. 

Out-of-state first responders and healthcare workers who use PPE as part of their daily work are exempt from the isolate-at-home portion of this requirement.

Name: ________________________________

 

Signed: ________________________________ Date: ______________

 

Mask agreement: All guests agree to wear masks in all indoor common areas throughout the hostel. (bedrooms excluded):

By signing this statement, I and all the individuals staying with me under my reservation agree to the hostel’s zero-tolerance mask policy:

  1. I will cover my mouth and nose with my mask in all indoor common areas throughout my stay (bedrooms are not common areas).
  2. If I am drinking a beverage in the common areas, I will keep my mask on other than when I take a sip of my beverage.  
  3. If I am eating in the common areas,  I will remove my mask only for the short period of time in which I am actually eating. 
  4. If I do not comply with this policy, I will immediately lose access to the common areas for the remainder of my stay.
  5. If I violate this policy more than once, I will be asked to leave and will not receive a refund for my stay.

Name: ________________________________

 

Signed: ________________________________ Date: ______________