COVID-19 Contact Tracing Form

Thank you for helping us ensure the safety of our musicians, staff, and patrons by providing this information.

The Altoona Symphony Orchestra will strictly follow HIPPA guidelines in relaying the information below. The information you provide will be used strictly as a means to alert others of any possible contact and the measures they must take to ensure minimal risk of further spread of the virus. Your name and other personal identifying information will be kept anonymous.

* Indicates required field

Name *

First

Last

Cellular Phone Number *

Ok to Text *

Yes No

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Instrument/ Section *

Choose One *

I have been made aware of a possible exposure. I have been exposed to a known positive. I have tested positive

Please list date of exposure or positive test result. *

Please provide the dates you were involved with Altoona Symphony Acitvities. *

Submit