Health Declaration | AJ Dance

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Covid-19 Health Declaration

How are you feeling?

Student First Name

Student 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

Parent / Guardian Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting! You MUST notify us immeadiately if you develop any symptoms of Covid-19.

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