CherryHill (PYO) COVID-19 Check In

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Name*

First Last

Phone*

Full names of any additional children (attending as guests):

Health Declaration – Part 1*

Agree

BY AGREEING TO THIS HEALTH DECLARATION, YOU ARE CONFIRMING THAT YOU OR YOUR DEPENDENTS DO NOT PRESENT WITH ANY OF THE BELOW SYMPTOMS: Fever • Cough • Shortness of breath

Health Declaration – Part 2*

Agreed

BY AGREEING TO THIS HEALTH DECLARATION, YOU ARE CONFIRMING THAT YOU OR YOUR DEPENDENTS HAVE NOT: Recently been in contact with someone diagnosed with Coronavirus to your knowledge, and have not traveled outside Australia in the last 2 weeks.

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