Aki Studio Covid-19 Health Declaration
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Email *
First Name *
Last Name *
Phone Number *
Date *
MM
/
DD
/
YYYY
Arrival Time *
Time
:
Please select any NEW symptoms you are currently experiencing *
Required
I agree that I have not tested positive for Covid-19 or knowingly been exposed to someone with Covid-19. *
Required
I agree that I have not been instructed by a health care officer to self isolate or received a Covid-19 alert *
Required
I agree that I have not travelled to an area with a high infection rate in the past 14 days, been in an area where social distancing was not properly observed. *
Required
If you are entering the studio with anyone who cannot fill out the form themselves (i.e minors) please list how many are entering with you
Check any that apply
A copy of your responses will be emailed to the address you provided.
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