Keep Maine Healthy
Certificate of Compliance for Maine Visitors

More than a place, Maine is how we live. Keep it Maine is about all of us working together, staying the course, remaining true to our spirit as a state. So far, Maine is keeping its COVID-19 infection rates and hospitalizations relatively low because we’re keeping to the values that tie us together. Let’s keep it up. Let’s keep it Maine.

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

I am a resident of the State of Maine, New Hampshire, Vermont.*

Yes
No

Compliance Questions

I certify that I have not experienced or displayed any of the following COVID-19 symptoms in the last 24 hours:*

Yes

Fever or chills
Sore throat, cough, shortness of breath, or other respiratory symptoms
Muscle aches, severe fatigue, or chills
Changes in taste or smell

I certify that I have not had close contact with anyone over the last 14 days who is confirmed to have COVID-19.*

Yes

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 arrival in Maine or for the duration of the stay
I have completed a 14-day quarantine in Maine prior to my stay.

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

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 in items 1 and 2.*

Yes
There is no one under the age of 18 in my care.

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 the negative test result upon request.*

Yes

Contact Information

The name on this form much match the name on your reservation.

First Name*

Last Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Email*

Enter Email Confirm Email

Additional Persons from the Same Household (Optional)

Estimated Arrival Time*

To help us best prepare for your arrival into Maine, please provide us your estimated arrival time into Portland. Check-In begins at 4pm daily. Although we cannot guarantee arrival times before 4pm, keys will be issued for your residence as soon it becomes available for occupancy.

:

*

I understand that arrival times prior to 4 pm may not be available. Our teams will use this information to prioritize the residence cleaning schedule for the day. As soon as your residence is fully inspected and available for occupancy, an email will be sent to you with your FLEXIPASS code.

Yes

Privacy

The information obtained in this document will be kept on file with 121 MIDDLE an urban inn for 30 days. After 30 days, this information will be removed and deleted from our website servers. This information may be shared with State of Maine officials, upon request.

Phone

This field is for validation purposes and should be left unchanged.

Keep Maine Healthy
Certificate of Compliance for Maine Visitors

Compliance Questions

Contact Information

Privacy

Get in touch with us

Contact Us

Portland
Maine

(207) 749-6409

contact@121middle.com

121 Middle Street

WINTER
rentals

Keep Maine HealthyCertificate of Compliance for Maine Visitors

Compliance Questions

Contact Information

Privacy

Get in touch with us

Contact Us

Portland Maine

(207) 749-6409

contact@121middle.com

121 Middle Street

WINTER rentals

Keep Maine Healthy
Certificate of Compliance for Maine Visitors

Portland
Maine

WINTER
rentals