COVID-19 Declaration Form

Name
MM slash DD slash YYYY
HH:MM

Symptoms

I declare that I do not have the following symptoms which are associated with COVID-19, including the following:

• Cold or Flu-like symptoms e.g. coughing, sore throat, fatigue
• Shortness of breath
• Fever
• Loss of sense of smell/taste

Symptom Declaration

Vaccine Status

I confirm that I have had a COVID-19 vaccination
MM slash DD slash YYYY
Please confirm whether you have been outside of the UK in the last 14 days
(A current Coronavirus Test Certificate will be required if this is a restricted country) CEDR reserves the right to refuse entry,

(A current Coronavirus Test Certificate will be required if this is a restricted country)

CEDR reserves the right to refuse entry.

MM slash DD slash YYYY
* Your typed name is acceptable
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