If everyone in your party has been vaccinated…

Please use this form to send Susan an email indicating that all have had the COVID-19 vaccine at least 2 weeks prior to your visit to the Green Cottage. You will need to provide proof of vaccination upon arrival. If not everyone has received their vaccination, instead continue to the Certificate of Compliance form further below.

    Note: You will receive a copy of the generated email too. If you don’t receive a copy, then it’s likely that the email went to your SPAM folder or you typed in your email address incorrectly. Please verify that you received an email copy.


    Certificate of Compliance

    TO VERMONT BE SMART, STAY SAFE EXECUTIVE ORDER 01-20 (4/09/2021 version)

    Please understand and complete the following form as required by the State of Vermont before your stay with us. Every item requires either a value or a click to the leading checkbox indicating you’ve read that item.

    If you prefer to complete the PDF and send or deliver it to us, you may download the form here. All details will be kept on file for 30 days and may be shared with the State of Vermont Government, should they request it of us.

      For information related to completing this form, visit: accd.vermont.gov/coc . You may choose to fill out and print that online form to remit a paper copy as well.

      1. I certify that one of the following applies to all in our group staying at The Green Cottage:

      • a. Have had a negative test result within three days before arriving in Vermont. The test must be for a current infection (like a PCR test), except it cannot be an antigen test (also known as rapid test); OR
      • b. Are authorized to work in Vermont; OR
      • c. Are fully vaccinated

      2. I also certify that no one in our group staying at The Green Cottage:

      • a. Had close contact with someone with COVID-19 in the past 14 days AND
      • b. Had COVID-19-like symptoms in the past 24 hours.

      3. By way of this form, I have been informed that out-of-state guests are encouraged to register with the Vermont Department of Health’s Sara Alert system and to provide updates to that system daily.

      I have read and understand this entire Certificate of Compliance and make the above certifications under the pains and penalties of perjury.


      This form is sent to susan@VacationRentalsInVermont.com. A copy will also be sent to your email.

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