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Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
Email
My body temperature is lower than 98.6°F/ 37.5°C
I am not experiencing the symptoms: fever, cough, sore throat
I haven’t been in close contact with a Covid-19 patient in the last 14 days
Initials
Date
I declare that the info I’ve provided is accurate & complete
Submit
Thanks for submitting!
Health Declaration
Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.
First Name
Last Name
Email
My body temperature is lower than 98.6°F/ 37.5°C
Are you experiencing any flu symptoms?
No
Yes
Choice 1
Date
Initials
I confirm that the information given in this form is true
Submit
Thanks for submitting!
