COEA College Day 2022

Registration Form

Name: ________________________________________ Year/Course: ___________________________________

Designation:

o UNIVERSITY OFFICIAL

o CAMPUS OFFICIAL

o COACH Event: _________________________________

o ATHLETE Event:
_________________________________
o TECHNICAL OFFICIAL Event:
_________________________________

HEALTH DECLARATION FORM

Yes No
1. Have you been in close contact with a confirmed case/s
of COVID 19?

2. Have you been in close contact with a person/s in

quarantine/probable case of COVID-19?

3. Do you have the following signs and symptoms with in the last 14
days?

Fever
Cough
Runny Nose
Sore Throat
Shortness of breath

4. Have you undergone COVID-19 detection testing?

If No, just leave the question; if Yes, kindly attach the result.
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Signature Over Printed Name Date