Declaration Form for Covid-19
For all students entering the BodyTalk Centre Singapore @ 38 Jalan Pemimpin #03-05 Singapore 557178
Sign in to Google to save your progress. Learn more
Name *
Date *
MM
/
DD
/
YYYY
Mobile No. *
BodyTalk and MindScape Classes *
Required
1) Have you travelled abroad in the past 14 days *
Required
2) Do you have flu-like symptoms (eg. fever, cough, running nose, sore throat or loss of taste/smell etc?) *
Required
3) Are you currently:   *
Required
4) Have you, in the past 14 days, had close contact with a Covid-19 person? *
Required
5) Have you been vaccinated for Covid-19 *
Required
Declaration as required by the Ministry of Health
The information you provide is important in managing the risk of Covid-19 transmission. The infections Disease Act requires a person who has reason to suspect that he is a case or carrier of Covid-19, or has had contact with a person with Covid-19, to act in a responsible manner to not expose other persons to the risk of infection by the disease.

Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms