Health form and attestation

Student First Name*

Student Last Name*

Email Address*

Mobile Phone Number*

Birthdate*

Click here if you are bringing any guest(s) with you to campus.

Not including yourself, how many guests are you bringing (max. 2)?

Guest 1 Full Name*

Guest 1 Email*

Guest 1 Mobile Phone Number*

Guest 2 Full Name*

Guest 2 Email*

Guest 2 Mobile Phone Number*

I agree that if anyone in my party tests positive for COVID-19 within 3 days of visiting Siena, I will inform the College by emailing Katie Szalda at kszalda@siena.edu.*

Attestation: I acknowledge that Siena College requires a mask without full vaccination, and my party will comply.

*denotes required field