To prevent the spread of COVID-19 and ensure the health safety of all attendees at any PABT functions and/or services involving Sensei Kodama, please complete the following ATTENDEE questionnaire.

This should be completed ON THE DAY OF the meeting/event/service attended.

You will need to show proof of completion of this form upon arrival.

Time of Meeting/Event/Service you are attending (Required)

Type of Meeting/Event/Service (Required)

Wedding/Funeral/Memorial/Inurnment Service NOT on PABT property

Wedding/Funeral/Memorial/Inurnment AT PABT property

Meeting/event NOT on PABT property

Meeting/event AT PABT property

What Meeting/Event are you attending or maintenance work are you doing? (Required)

First Name

Last Name

Number of children (less than 18 yo) attending the meeting/event/service with you (Required)

Please enter the names of the children less than 18 years old attending. Anyone over 18 years old should fill out their own individual forms.

Street Address

Street Address Line 2

City

State

Postal / Zip code

Phone

Thanks for submitting!