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Luna
Mountain
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for all bodies and all hearts
Covid-19 Health Declaration (in-person only)
How are you feeling today?
First Name
Last Name
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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 accurate & complete
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