Gymnastics Meet Health Declaration Form
Participant Name
Age
Parent / Guardian Name (if under 18)
Contact Email
Contact Phone
1. Health in the last 14 days
Have you experienced any of the following in the last 14 days?
Fever
Cough
Shortness of breath
None
2. Recent Travel
Have you traveled outside your state or country in the last 14 days?
No
Yes
3. Exposure
Have you been in contact with anyone diagnosed with a communicable illness in the last 14 days?
No
Yes
4. Other Relevant Health Information
Please provide any other information regarding your current health status:
Declaration & Signature
Signature
Date