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Covid-19 - Boarding School Health Declaration

How are you feeling today? Please complete the following student contact track and trace form:

First Name

Last Name

which School do you attend?

Boarding House

I have flown in from

Who is you Driver?

Date

I haven’t been in close contact with a Covid-19 patient in the last 14 days

I agree to sit in the back of the car, wash hands and wear a mask if requested by the driver.

I am not experiencing any symptoms of Covid 19 fever, cough, sore throat, loss of taste or smell and to the best of my knowledge my body temperature is lower than 98.6°F/ 37.5°C.

Thanks for submitting!

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