Declaration Form | Manghat-Family-Tree

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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

My body temperature is lower than 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Date

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

Thank You For Submitting!

©2019 owned by Jaya Prakash, Gayathri Prakash, Roshini Prakash, Vandana Prakash and Pavithra Prakash.

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