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Women's Reiki Certification Retreats

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient or anyone who has had any kind of illness in the last 14 days.

I have had a Covid 19 test in the last 14 days and the results were negative. (If you select this box, I will need a copy of test results emailed to lindag@prescottreiki.com immediately)

Full Name

Date

I declare that the info I’ve provided is accurate & complete.

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Location: Prescott, Az.

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