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       This will be filled out when you arrive

You will fill this out when you arrive.

COVID-19 Statement of Symptoms and Quarantine.

MASKS must be worn in any of our buildings except while in your room and eating



Pursuant to the Governor of New Hampshire's Emergency Order 27, all registered guests must
attest that they are exhibiting no symptoms of COVID-19. Additionally, registered guests
checking in must provide a New England license as proof of New England residency or, for out-of-New England guests, must provide a license and attest that they have quarantined at home for 10 days.


NOTE: You do NOT need to quarantine for 10 days or get tested for COVID-19 if you are fully vaccinated against COVID-19 and more than 14 days have passed since you received the second dose, if needed by your type of COVID-19 vaccine.

Symptoms and Vaccine Statement (Required by all guests)

      By signing this statement I, attest that no one in my party is currently exhibiting any symptoms or has been in contact with the of COVID-19 virus.  

a. Any 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) _________YES  ________NO

b. Are you experiencing a cough, shortness of breath or sore throat? _________YES _________NO

c. Have you had a fever in the last 24hours? ________YES ________NO

d. Have you had changes in your sense of taste or smell? ________YES _________NO

e. If you answered yes to any of these questions, please do not put us or other guests at risk and come back another day when you feel better. Any deposit made will be returned if you arrive and you cannot stay due to the COVID-19 Virus.

f. Vaccines: Fully Vaccinated _______, Waiting for second dose if needed _______, None _______


You must show your vaccination card(s) at time of arrival.






Address: Street_________________________ Town______________________ State______ Zip ______



Email:________________________________ Telephone ______________ Date____________________

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