TRAVELER’S HEALTH DECLARATION/QUESTIONNAIRE

To be completed and signed prior to boarding by all persons. One form per person
Health form must be received prior to departure. If not, this may result in possible delays.

Date*
DEP Airport*
AAR Airport*
Name (as it appears on Passport/Driver’s License/Birth Certificate)*
Please provide contact information, should we have any questions
Phone*
Email*
TO ASSIST US IN PROTECTING THE HEALTH AND SAFETY OF PASSENGERS AND CREW YES NO ON THIS FLIGHT, WE REQUIRE YOU TO ANSWER THE FOLLOWING QUESTIONS:

Have you traveled internationally in the past fourteen (14) days?* YesNo

If so Where?
Have you, or any person listed above, had close contact with, or helped care for, anyone suspected or diagnosed as having Novel Coronavirus, or who is currently subject to health monitoring for possible exposure to Novel Coronavirus?* YesNo
Have you been diagnosed and subsequently recovered from COVID-19? If so, when did you receive clearance from your health provider to resume normal activity* YesNo
Do you have a fever (99 F° / 37.2 C° or higher), feel feverish, or have chills, a cough or difficulty breathing?* YesNo

If you have answered yes to any of the above questions, a Skytech representative will be in contact, as a passenger may be denied travel.

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*
Date*
Or Signature of parent or guardian (if traveler is under 18 years of age)
Date
*By typing your name in the box below, you are electronically signing this document. Your electronic signature is legally binding and enforceable and the legal equivalent to your handwritten signature*

TRAVELER’S HEALTH DECLARATION/QUESTIONNAIRE

TO ASSIST US IN PROTECTING THE HEALTH AND SAFETY OF PASSENGERS AND CREW YES NO ON THIS FLIGHT, WE REQUIRE YOU TO ANSWER THE FOLLOWING QUESTIONS:

If you have answered yes to any of the above questions, a Skytech representative will be in contact, as a passenger may be denied travel.