Shakti Yoga Centre Covid Declaration Form

Self-Health Declaration Form For the health and safety of our community, declaration of illness is required. Be sure that the information you'll give is accurate and complete. Please get immediate medical attention if you have any of the COVID-19 signs.
Name
Cell Number
Email
Have you been in contact in the last 14 days with someone who is confirmed, suspected or diagnosed to have COVID-19.
Have you traveled internationally or a local hot spot areas in the last 14 days?
Please state whether you've experienced/are experiencing the following
DECLARATION I hereby declare to the best of my knowledge that the information disclosed is correct at the time of completion. I further undertake to inform the teaching staff at Shakti Yoga Centre should I be diagnosed with COVID-19 within the next 14 days so as to facilitate contact tracing.