COVID-19 Adventure Travel Health Declaration Form
Personal Information
Full Name
Passport/ID Number
Nationality
Date of Birth
Email Address
Phone Number
Travel Information
Adventure Trip Name
Date of Arrival
Country of Departure
Health Declaration
Have you experienced any of the following symptoms in the last 14 days?
Fever
Cough
Shortness of breath
Sore throat
None of the above
Have you tested positive for COVID-19 in the past 14 days?
Yes
No
Have you been in contact with anyone diagnosed with COVID-19 in the last 14 days?
Yes
No
Please provide details of any existing health conditions or medications
Declaration
I confirm that the information provided above is accurate and complete. I understand that providing false information may affect my participation.
Signature:
Date: