Health Declaration Form

By Checking the box below, I hereby certify, as follows:
Within the (14) days immediately before the date of this Health Declaration Form, I HAVE NOT:
a. tested positive with COVID-19 or been identified as a potential carrier of COVID-19 virus or similar communicable illness;
b. experienced any symptoms associated with the COVID-19; fever, cough, or shortness of breath
c. been in direct contact with or in the immediate vicinity of a person I knew and/ or now know to be carrying COVID-19.

By Checking the box below, I here by affirm that this business is not legally liable for the transmission of viruses and the actions of other patrons.