Pre-Visit Screen Form

Academy at Charlemont Pre-Visit Screen

Thank you for completing this form in advance of your visit to The Academy at Charlemont! We look forward to welcoming you to campus. Please note: each individual in your party must complete this form ahead of your visit. Visitors to The Academy entering our buildings beyond our foyer area and interacting with community members for an extended period are required to share either 1) proof of COVID-19 vaccination, or 2) proof of a negative COVID-19 PCR test within 72 hours of the scheduled visit. Responses to this form will be viewed only by our Co-Heads of School. We thank you for helping to keep our community safe. We will not contact you about your response unless there is an issue with any information shared herewith.
Name
I am a
If you have been fully vaccinated (two weeks have passed since your final dose) against COVID-19, please indicate below and upload a copy or picture of your vaccination card below.
Max. file size: 128 MB.
If you have received a negative COVID-19 PCR test result in the last 72 hours, please indicate that here and upload proof of such results (if you have not provided proof of full vaccination).
Max. file size: 128 MB.