Covid-19 Declaration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Initial Caps in names (Joe Schmoe), please, Name *FirstMiddleLastAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryLayoutMobile Phone *Date of Birth / DOB *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email *EmailConfirm EmailEmergency Contact - must be someone not with youName *FirstLastLayoutRelation to You *Best Emergency Phone *Applicable Workshop(s)Select single or twofers *New Orleans, The BIG Easy 2024Many Faces of Charleston 2024Blue Ridge Mountain Magic 2024Monhegan Island, Artists' Paradise 2024Both Maine Workshops 2024Summertime on the Maine Coast 2024Dakota Badlands 2024Both Northwest Workshops 2024Palouse, Echoes of Tuscany 2024Paris, City of Light 2024Both European Workshops 2024Lake Garda & the Dolomites 2024Scout & Shoot 2024Private Workshops on Location 2024Only one COVID-19 Declaration per person. I attest to the fact that I have: Been fully vacinated against COVID-19 acording to current CDC guidelines and have a certificate for same; Been tested (self or otherwise) for COVID-19 five days before the start of the workshop; Been careful to avoid situations where I might be infected after testing; and Have NOT experienced symptoms of (please read carefully) (1) fever of 100.4°F (38°C) or higher, (2) cough, (3) shortness of breath or difficulty breathing, (4) chills, (5) muscle pain, (6) sore throat, (7) new loss of taste or smell, (8) fatigue, (9) body aches, (10) headache, (11) congestion or runny nose, (12) nausea or vomiting, (13) diarrhea, or (14) any other symptoms relating to COVID-19 or any communicable disease. AND ... (please check) *Out of respect for my leader(s) and fellow participants, if I exhibit any of the CDC-listed symptoms to the left, I will not attend the workshop or reunion and risk infecting others. I fully understand that Barefoot Contessa Photo Adventures encourages everyone to take out trip insurance that covers COVID-19 (see ourAllianz link for such coverage).AND ... (please check) *I understand that out of respect for my leader(s) and fellow participants, if I develop any of the CDC-listed symptoms to the left during a BCPA workshop or reunion, I will be asked to leave, notify our inn or hotel, and if appropriate, seek medical attention.AND ... (please check) *I am 18 years or older and have carefully read, understand, and attest that all the information in this form is true.Applicant Signature (type as you would write your signature) *Submit
