Health Declaration Form
Please fill out the form below, in view of the Covid-19 situation. It is mandatory for all participants to fill out this form and pass the criteria prior to entry to the event. Thank you!
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Full Name *
Mobile Number *
Email Address *
Date of Event Attended *
MM
/
DD
/
YYYY
Temperature measured (deg C) *
Do you have any of the following symptoms: fever (>37.5°C), cough, breathlessness, sore throat, runny nose? *
Have you travelled overseas in the past 14 days? *
Have you been in any contact with anyone who has been issued a Quarantine Order, Leave of Absence, Stay Home Notice or equivalent in the past 14 days? *
Are you under a Leave of Absence (LOA), Stay Home Notice (SHN) or pending Covid test results? *
I understand that if I am under a Leave of Absence, Stay Home Notice, or have any flu symptoms, e.g. fever (>37.5°C), cough, breathlessness, sore throat, runny nose, I am advised to stay home and rest, as a way of social responsibility to the group. *
I hereby declare that all the particulars provided in this form are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false, incorrect or ineligibility being detected before or during the event, I understand that I will be refused entry to the venue of the event. *
Message from organizer:
Thank you for taking the time to fill this form out for us! If you have are under a SHN, LOA, pending swab test results or feeling unwell, we ask that you kindly refrain from attending the event. You are always welcome to join us for future meditation events. Please contact Li Xuan @ 98573788 for any questions or changes to your attendance.
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