Covid-19 Submission Form - The Casitas Estate

Time to celebrate

Event Guidelines

Are Here and In Effect.

April 15, 2021

Thank you for your participation in completing the Covid-19 Submission form below. The State of California requires that all guests and vendors must provide the venue with either a negative Covid-19 test (within 72 hours of the event) or proof of a completed Covid-19 vaccination under the Private Venues and Events Guidelines.

The information you are submitting today is confidential and will only be viewed by The Casitas Estate team, unless requested by the San Luis Obispo Public Health Department.

Please know that you are not required to submit proof of vaccination. If you would like that information to remain confidential, you may instead submit a negative Covid-19 test (within 72 hours of the event).

Thank you for helping us keep our onsite events safe and within state compliance!

COVID-19 Submission Form

What event will you be attending at The Casitas Estate?

I am onsite as a:

Guest

Vendor

Business Name (for Vendors)

CONTACT INFORMATION

First Name

Last Name

Location:

City

State

COVID-19 DOCUMENTATION

Please keep in mind that the information you are submitting today is confidential and will only be viewed by The Casitas Estate Team, unless requested by the San Luis Obispo Public Health Department.

Also, please know that you are not required to submit proof of vaccination. If you would like that information to remain confidential, you may instead submit proof of a negative COVID-19 test (within 72 hours of the event).

I wish to submit the following as a form of Covid-19 mitigation

Negative COVID-19 Test Results (within 72 hours of the event) *if this is checked be sure to SUBMIT PROOF BELOW

Proof of Completed Vaccination *If this is checked make sure to SUBMIT PROOF BELOW

I certify and verify that I have taken a negative COVID-19 test (within of 72 hours of the event), however, I will not be providing proof

I certify and verify that I have a legitimate COVID-19 vaccination, however, I will not be providing proof

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DECLARATION & RELEASE

I declare (or certify, verify or state) under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. I understand by submitting this form I am taking sole responsibility for my actions and the repercussions of those actions.

In consideration for being allowed to participate in this Activity, on behalf of myself, my minor children, my heirs, my invitees and my staff, I release from all liability and promise not to sue Host, The Casitas Estate (including all legal business names attached to the business), and/or their officers, agents, and employees from any and all claims including without limitation claims of Host's negligence, resulting in any injury, death, illness (including COVID-19 related illnesses) damage, or economic or emotion loss I may suffer because of my participation in this Activity, including travel to, from and during the Activity.

I am 18 years or older. I understand the legal consequences of submitting this form, including (a) releasing Host and The Casitas Estate (including all legal business names attached to the business), from all liability; (b) promising not to sue Host; and (c) assuming all risks of participating in this Activity, including travel to, from and during the Activity.

Time to celebrate

Event Guidelines

Are Here and In Effect.

April 15, 2021

CONTACT INFORMATION

COVID-19 DOCUMENTATION

DECLARATION & RELEASE

San Luis Obispo Wedding Venue

2655 Lopez Dr, Arroyo Grande, CA 93420

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