Certificate of compliance

Keep Maine Healthy Certificate of Compliance for Maine visitors

To help “Keep Maine Healthy,” guests of Maine commercial lodging establishments, campgrounds, seasonal rentals, or short-term rentals are required to complete this certificate prior to their stay. This initiative promotes the safety of Maine residents and visitors coming to enjoy all that Maine has to offer.

Please note that every adult in your party must complete the Certificate of Compliance form. Guests under the age of 18, or residents of Maine, New Hampshire and Vermont, do not need to fill out the Certificate of Compliance.

To that end, the State of Maine asks you to review and attest to the following:

I certify that I have not experienced or displayed any of the following COVID-19 symptoms in the last 24 hours:*
- • Fever or chills
- • Sore throat, cough, shortness or breath, or other respiratory symptoms
- • Muscle aches, severe fatigue, or chills
- • Changes to taste or smell
- I have experienced no symptoms
I certify that I have not had close contact with anyone over the last 14 days who is confirmed to have COVID-19.*
- I have not had close contact with a confirmed COVID-19 case
I certify that ONE of the following is true (PLEASE CHECK ONE):*
- I have received a negative test result for COVID-19 on a specimen taken no later than 72 hours prior to my arrival, consistent with Maine CDC guidance.
- I will quarantine for 14 days upon my arrival in Maine or for the duration of the stay
- I have completed a 14 day quarantine in Maine prior to my stay
(Note: Visitors may be tested for COVID-19 in Maine, but must remain in quarantine while awaiting the result.)
While in Maine, I agree to do my part to Keep Maine Healthy by following recommended safety measures in order to protect myself and others.*
- Yes
- No
I also certify that all persons in my care who are under the age of 18, or who are dependent on my care, meet the criteria described above. Please provide the ages of such persons in your care.
I have read and understand this entire Certificate of Compliance and agree the certifications made above are accurate. Visitors may be asked to furnish proof of negative COVID-19 test upon request.*
Please type your electronic signature in the space below*
Address*
Home Phone*
Phone while in Maine*

Contact Us

Cottage in the Lane
84 Drakes Island Road
Wells, ME 04090

t: (207) 646-7903
e: info@cottageinthelane.com

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Certificate of compliance

Keep Maine Healthy Certificate of Compliance for Maine visitors

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