Ivory Manor Covid-19 Declaration
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Who's Function are you attending? *
Name and Surname *
Contact Number *
Contact Email *
Date *
MM
/
DD
/
YYYY
Have you experienced at least one of the following symptoms recently? (tick if applicable)
Have you attended any healthcare facilities where patients with Covid-19 infections are being treated? *
Have you been hospitalised recently with severe pneumonia? *
Do you currently have flu symptoms? *
I declare that all the above information is true and correct *
Required
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