COVID 19 Self Declaration Form

With this form, I acknowledge that the below statements are true and correct to the best of my knowledge.

AISK closely monitors the global COVID-19 situation on a daily basis and follows directives from the Ministry of Health and wellness, Ministry of Education and the WHO. The health and wellbeing of our community is our first priority and at this time we ask you to answer the following questions.
 
AISK reserves the right to deny entry to the campus.
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Date *
MM
/
DD
/
YYYY
Reason for visiting *
Required
Currently, do you have any of the following symptoms? *
Required
To your knowledge, have you been in contact with a person who has travelled/stayed in one of the COVID-19 affected areas in the last 14 days?
Clear selection
Have you travelled or stayed in any of the COVID-19 affected areas in the last 14 days? *
Please see below the list of COVID-19 affected areas indicate if have you travelled to any of these countries in the last 14 days? (Source: WHO and MoHW) *
Required
If other, please indicate which country
Have you self-imposed or been quarantined by the Ministry of Health after your arrival from travel to these countries?
Clear selection
Temperature Reading? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of The American School of Kingston. Report Abuse
Google Forms