TRAVELER’S HEALTH DECLARATION

TRAVELER’S HEALTH DECLARATION/QUESTIONNAIRE
To be completed prior to boarding by all persons. One form per person.
Date *

Month Day Year
Date
Name (as it appears on Passport/Driver’s License/Birth Certificate) *
TO ASSIST US IN PROTECTING THE HEALTH AND SAFETY OF ALL PASSENGERS AND CREW ON THIS FLIGHT, WE ASK THAT YOU COMPLY WITH FEDERAL AVIATION REGULATIONS.
YOUR COMMITMENT TO SAFETY
- If traveling within the United States, I confirm that I am not currently required to isolate or quarantine due to COVID-19 exposure, symptoms, or a positive diagnosis under the current CDC COVID-19 guidelines.
- If traveling internationally, I confirm that I am not currently required to isolate or quarantine due to COVID-19 exposure, symptoms, or a positive diagnosis under the current public health regualtions at the origin and destination.
I certify that the above declaration is true and correct and understand that any dishonest answers may have serious public health implications.
Signature of Traveler: *

Clear
Date *

Month Day Year
Signature of Parent/Guardian if traveler is under 18 years of age:

Clear
Date:
Should be Empty:

TRAVELER’S HEALTH DECLARATION/QUESTIONNAIRE