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. All visitors to The Academy entering our buildings beyond our foyer area and interacting with community members for an extended period are required to share proof of full vaccination or a negative COVID-19 PCR test within 72 hours of the scheduled visit. If needed, test results can include information from weekly pooled testing. Responses to this form will be viewed only by our Co-Heads of School. Please note that Greenfield Community College's testing site does accept walk-ins during their scheduled hours. 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

First Last

Date of your planned visit to The Academy

Time of your planned visit to The Academy

I am a

Prospective student

Prospective parent/guardian

Prospective grandparent

Current parent/guardian

Current grandparent

Other

If you answered "other" to the question above, please specify your relation to The Academy

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.

I am fully vaccinated against COVID-19

Please upload a copy or image of your vaccination card here.

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 (required for all on-campus visitors as of January 2022).

I have a negative PCR test for COVID-19 from the last 72 hours

Please upload proof of negative test results here (if you have not provided proof of full vaccination).

Max. file size: 128 MB.