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Tzofim- Israeli Scouts UK

ONE FORM PER MEMBER CHILD

Covid-19 Health Declaration

How are you feeling today?

Member's First Name

Parent's Phone No during the activity

Member's Last Name

Email

My child's body today temperature is lower than 37.5°C

He/She is not experiencing the symptoms: fever, continous new cough, sore throat

He/she haven’t been in close contact with a Covid-19 patient in the last 14 days

Your Initials

Date

I declare that the info I’ve provided on behalf of my child is accurate & complete

Thanks for submitting!

This form should be submitted on the day of the activity ONLY!

Israeli Scouts Western Europe

Registered Charity No. 1156815
1 Ballards Lane, London, N3 1LQ
Tel: +44(0)208 371 5285 | E-Mail:

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