Covid Level Form
This form will help match you with families with similar COVID levels of exposure and precautions!
The more details the better!
First name
*
Please provide your first name.
Last name
*
Please provide your last name.
Email
*
Please provide your email address.
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Have you received the COVID vaccine?
Yes
No
Have you received just Dose one? or both doses?
Both
Just dose one
Of the three levels, which most accurately reflects your current level of precautions?
Level 1
Level 2
Level 3
Would you be willing to adjust your precautions to align with the family's?
Yes
No
Do you wear a mask in public?
Yes
No
Are you socially distancing?
Yes
No
How many people are in your household?
0-1
1-2
2-3
4+
Do you have any household members who work in high-risk situations?
Yes
No
Please add a photo of your Covid card
Do you or your household members work remotely at home, or leave for work?
Are you willing to limit your exposure with friends and others?
Yes
No
Do you have any close family members you are socially distancing for?
Please describe any other details you wish to share or precautions you are taking:
*
A required field is missing. Please check the form and make sure all required fields have been filled, including a profile picture if required.
Submit
