Declaration form for travel history and health status of students  (Proforma B)
2021년 1학기 홍콩한국토요학교 Korean Saturday School H.K.
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Please complete the below form and submit (Please put a “ √ ” in the appropriate box)
성명 등 한국어로 작성하셔도 됩니다.
Name of Student : *
Class : *
Sex: *
Part A – Travel history of your child outside Hong Kong in the past 14 days *
(A-1) Duration:  From___①___ (Month)___②___ (Day) (Departure date)   To___③___ (Month)___④___ (Day) (Arrival date)
(A-2) Destination (Please specify countries and cities) : ________________________________
Part B – Whether your child has confirmed infection of COVID-19 *
(B-1)  Hospitalization Period:  From___①___ (Month)___②___ (Day)  To___③___ (Month)___④___ (Day)
Part C – Health status of those taking care of your child, or those living with your child *
(C-1)Person taking care of or living together with my child has confirmed infection for COVID-19, the person
Part D – Current health status of your child *
Name of Parent/Guardian: *
Date: (dd/mm/yyyy) *
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