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971-285-1858

layakinti@gmail.com

Covid-19 Health Declaration

How are you feeling today?/Como se siente hoy?

First Name/Nombre

Last Name/Apellido

Email

My body temperature is lower than 98.6°F/ 37.5°C /Mi temperatura es menos de 98.6 F/37.5 C

I am not experiencing the symptoms: fever, cough, sore throat /No tengo sintomas de fiebre, tos o dolor de garganta.

I have received a Covid vaccine. He recibido la vacuna para el Covid.

Initials

Date

I declare that the info I’ve provided is accurate & complete/Declaro que toda esta informacion es cierta, completa y correcta.

Thanks for submitting!

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