Student Quarantine Clearance Declaration Form
Student Name
Student ID Number
Program / Course
Year Level
Quarantine Start Date
Quarantine End Date
Quarantine Location / Address
Reason for Quarantine
Close contact with confirmed COVID-19 case
Confirmed COVID-19 case
Others
Did you experience any symptoms during quarantine? If yes, list here:
Declaration
I hereby declare that I have completed the required days of quarantine and am fit to resume school activities.
Student Signature
Date