Covid Form | River City Fitness

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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat, shortness of breath, difficulty breathing, painful swallowing

I am not experiencing the symptoms: nausau, vomiting, diahrrea, felling unwell/fatigued, unexplained loss of appetite, lost sense of smenll or taste, muscle joint aches, headaches, pink eye

I haven’t, nor has anyone in my household been in close contact with a Covid-19 patient, or a person being tested for Covid-19 in the last 14 days

Initials

Date

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

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