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Health Declaration
Please fill this form correctly, i
f you do not fill the form correctly WE are liable for prosecution by the govt, can be fined, and even forced to close.
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ANYONE FOUND LEAVING FALSE CONTACT DETAILS WILL BE ASKED TO LEAVE THE PREMISES.
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Details will not be used for any reason other than contacting you in event of contact with confirmed covid case.
First Name
Last Name
Phone
My body temperature is lower than 98.6°F/ 37.5°C
Date
I confirm that the information given in this form is true
Submit
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