COVID-19 Waiver Form | MUSKOKA MOTOR RALLY

Covid-19 Health Declaration

I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeating shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.

I have not travelled internationally within the last 14 days.

I have not traveled to a highly impacted area within the United States of America in the last 14 days.

I do not believe that I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.

I have not been diagnosed with Coronavirus/COVID-19 and not yet cleared as non-contagious local public heath authorities.

I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

First Name

Initials

Last Name

Date

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

Thanks for submitting!