Panther (Community) Activities Travel Disclosure

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Further to the Thai Ministry of Education directive NO. SorTor 0211.6/, dated 24th February 2020, we are requiring all ISB families, staff, faculty, associates and any non-ISB families whose family members participate in activities at ISB to submit a self-declaration form with respect to recent travel and close contact for all members of the household. The Ministry of Public Health is launching special measures to ensure accurate reporting. ISB requires this self-disclosure to best maintain a safe environment for our community and comply with the government requirements. Campus entry is dependent on the accurate completion of this form.

Each Associate must complete this form before 7am on Monday 2nd March.

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E-post *

First and last name *

Phone number *

With which organization(s) at ISB are you or your family members most closely associated (Panther Tennis, IMP, Girl Scouts, etc.)? *

What is your title or role within this associate organization (coordinator, coach, assistant, volunteer, participant, etc.)? *

Coordinator

Coach

Assistant

Volunteer

*Non-ISB family whose family members participate in activities at ISB

Obligatorisk

*If you answered, "Non-ISB family whose family members participate in activities at ISB" above, list the names and ages of all family members who participate in activities at ISB below, and what school, if any, they attend.

Please enter the names of all other members of your household (spouse, children, grand-parents, visitors, etc.). *

Choose the statement that best describes your household: *

I confirm that none of the above listed children or adults living in the same household have traveled to or transited through one of the following high risk areas in the past 14 days: China, Hong Kong, Iran, Italy, Japan, Macau, Singapore, South Korea, Taiwan, Germany, and France. (if you select this, skip to section 3) .

I confirm that AT LEAST ONE of the above students or adults living in the same household have traveled to or transited through one of the above listed risk areas in the past 14 days, and will therefore keep all students in my household in self-quarantine until 14 days have passed since the date of leaving, or transiting through, the risk area. I also confirm that no household member will enter the ISB campus. (if you select this, complete the next question)

*Our situation is more complex and needs further explanation. Please describe below.

Please list all overseas destinations and travel dates your household members have visited or transited through in the 14 days prior to the date this form is being filled out. *

Confirmation and agreements. *

By checking this box I confirm that the information given in this form is true, complete and accurate. I also confirm that should at least one of the above students or adults living in the same household travel to or transit through one of the above listed risk areas, or additional areas as listed by the school in the future, we will keep all students in my household in self-quarantine until 14 days have passed from the date of the traveler returning to the household. We will also notify the school.

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