Health Declaration Form

I hereby certify, represent and warrant as follows:

Within the fourteen (14) days immediately preceding the date of this Health Declaration Form, I HAVE NOT:

• Tested positive or presumptively positive with the Coronavirus or been identified as a potential carrier of the COVID-19 virus or similar communicable illness;

• Experienced any symptoms commonly associated with the Coronavirus;

• Been in direct contact with or the immediate vicinity of any person I knew and/or know to be carrying the Coronavirus within the last fourteen (14) days.