Health declaration | Open Art Space

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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

I am fully vacciated for COVID-19

My body temperature is lower than 100.4 degrees

I am not experiencing any of the symptoms: fever, cough, sore throat, new loss of taste or smell

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

Initials

Date

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

Thanks for submitting!

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