EmailMeForm
CHAMPION TKD Covid Questionnaire
Childs Full Name
*
First
Middle
Last
School
*
Year level
Parents Name
*
First
Last
Home Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Email
Phone
###
-
###
-
####
Questions
Have you been around or you are living with anyone that has tested positive for Covid-19?
YES
NO
Have anyone in your household recently travelled?
YES
NO
Is anyone in your household currently experiencing any flu like symptoms such as cold/fever?
YES
NO
Has anyone in your household been instructed by The Government of Bermuda to self-quarantine?
YES
NO
