Travel & Health Declaration Form Travel & Health Declaration Form Dear Parent/Staff, In order to ensure the continuous wellbeing of School community (Students/Staff/Parents), as per the current prevention and control policy of COVID-19, Dubai Health Authority requires you to provide information regarding history of travel in the last 14 days and health status. Please report and update regularly in case of travel. {{warmsg}} * {{warmsg1}} School Name School Name Required You exceeded number of accepted characters (255) School Name should not contain special characters School Email School to assign one unified email ID, so all traveled school student/staff report to this email. Not staff/student email ID School Email Required School Email is invalid You exceeded number of accepted characters (255) Are you Parent on behalf of Student Staff Required Staff Name Staff Name Required You exceeded number of accepted characters (255) Student Name should not contain special characters Student Name Student Name Required You exceeded number of accepted characters (255) Student Name should not contain special characters Grade Select {{option}} Grade Required Date of Birth Date of Birth Required Parent/Guardian Name Parent/Guardian Name Required You exceeded number of accepted characters (255) Parent/Guardian Name should not contain special characters Relationship Relationship Required You exceeded number of accepted characters (255) Relationship should not contain special characters Emirates ID Emirates ID Required please enter in this format e.g 123-1234-1234567-1 Nationality Select {{option}} Nationality required Gender Select {{option}} Gender required Address Address required You exceeded number of accepted characters (2000) Emirate Select {{option}} Required Any History of travel in last 14 days? Yes No Required Country Visited Country Visited Required You exceeded number of accepted characters (2000) Date of Travel Date of Travel Required Date of Arrival Date of Arrival Required Duration of Stay Duration of Stay Required Any history of contact with confirmed COVID-19 in the last 14 days Yes No Required Any current fever or flu like symptoms Yes No Required Any PCR test was done Yes No Required Date of PCR test taken PCR test date is required PCR Result Select {{option}} PCR result is required Other Notes You exceeded number of accepted characters (2000) Contact Number Select {{option.Title}} Send OTP Contact number is invalid Contact number required OTP Verification Code OTP Required Entered OTP is Incorrect I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief, and I undertake the responsibility to inform school clinic of any changes therein, immediately. Please accept the terms and condition This field is required. Submit Success! Your form sent successfully, we will review your form and contact you for more detail. Your reference no. is: {{recordno}}
