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Blue Ridge Mountian Guides, LLC 

1097 Crawfords Climb 

Nellysford, VA 22958 

info@blueridgemtnguides.com

(276) 732-2001 

 

Pre-Trip COVID-19 Screening

Questionnaire and Acknowledgment of Policies 

(Please complete this by 48 hours prior to your trip

 

Please complete a screening for everyone participating.
AdultMinor
Continue
First Guest's Name

First Name*

Last Name*
First Guest's Date of Birth*
First Guest's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
COVID-19 Questionnaire
1. Have you, or has anyone you have been in close contact with, tested positive for COVID-19 in the past 14 days? *
No
Yes
2. Have you, or has anyone you are in close contact with, had COVID-19 symptoms in the last 14 days? These symptoms include fever, chills, cough, shortness of breath or difficulty breathing, new loss of taste or smell, muscle pain, or sore throat. *
No
Yes
3. Have you, or has anyone you are in close contact with, returned from international travel in the last 14 days? *
No
Yes
4. After completing this questionnaire, if any of your responses change prior to your trip, notify BRMG as soon as possible. *
I Understand
5. Your temperature will be measured on each day of your trip. Parties with an individual whose temperature exceeds 100.4F will be required to reschedule. *
I Understand
Acknowledgment of COVID-19 Policies
1. Guests and guides must wear a face covering when within 6 feet of each other or anyone else during the trip. *
I Agree
2. Guests and guides should maintain 6 feet of physical distance from others when possible. However, due to the inherent nature of climbing and skiing, this may not always be possible. *
I Agree
3. We recommend washing or sanitizing your hands after touching common surfaces or gear, especially before eating, drinking, or touching your face. *
I Agree
4. We are not permitting loose chalk at this time. If you would like to climb with chalk, please bring a chalk bag and ball or liquid chalk. *
I Agree
5. Groups of guests that are large enough to be subject to a local, state, or federal group size restriction must travel and congregate appropriately so as to abide by those restrictions. *
I Agree
6. The above COVID-19 policies are necessary to reduce risk to BRMG guests and guides. Trips may be ended early if a guest or guide fails to abide by these policies. *
I Agree
Parent(s) or court-appointed legal guardian(s) must complete a screening for themselves and for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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