Health Declaration | Dysmithwright

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Covid-19 Health Declaration

How are you feeling?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

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

Initials

Date

I declare that the info I’ve provided is honest, accurate & complete

I understand that WOW Faith, LLC has put in place preventive measures to reduce the spread of Covid-19 ie tempature checks, sanitation, & masks availibity. Furthermore, by submitting this form, I am releasing WOW Faith, LLC and employees from any and all liability for the unintentional exposure or harm due to COVID-19.

Thanks for submitting!

Email: Wowfaithllc@gmail.com

Phone: 910-446-3506

1930 club pond rd #1087

Raeford, NC 28376

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