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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

Nobody in the family has a temperature.

Nobody in the family is experiencing the symptoms: fever, cough, sore throat

Nobody in the family has 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

Learner's name

Thanks for submitting!