Covid 19 Waiver Form Covid 19 Waiver Form Name Email Date of Birth Phone Do you have any of the following symptoms at present (please check): Cough & runny nose, not due to seasonal allergyFeverSore throatDifficulty breathingRecent loss of taste or smellGeneralized body achesDiarrhea Do any of the family members, living in your household currently or within the past 10 days, have or have had any of the above symptoms? YesNo Have you traveled in an airplane in the past 10 days? YesNo If the answer to any of the questions is Yes, or the temperature is 100 F or more, you will be rescheduled. Covid 19 Waiver Form was last modified: November 22nd, 2023 by Rahul Adya
