Club Marcella of Buffalo

Live Entertainment Venue

New York State Required Contract Tracing Form

The following information is REQUIRED by New York State and the NYS Dept of Health.  Please complete all requested information before pressing SUBMIT.

 

PLEASE NOTE:  THIS INFORMATION WILL NOT BE SHARED WITH ANYONE UNLESS CLUB MARCELLA RECEIVES A CONTACT TRACING REQUEST FROM THE HEALTH DEPARTMENT.  OTHER THAN CONTACT TRACING, YOUR PRIVATE INFORMATION WILL NOT BE SHARED, DISCLOSED, OR SOLD TO ANYONE.  

 

AS REQUIRED BY NYS, THIS INFORMATION MUST BE KEPT FOR A MINIMUM OF 28 DAYS.  

NYS Covid-19 Contract Tracing

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The following statements MUST be answered to continue.  Failure to answer these statements will prevent your entrance to Club Marcella!

Thanks for submitting!