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Dietetic Services
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Health Declaration

Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

Are you experiencing any flu symptoms?

No

Yes

Date

Initials

I confirm that the information given in this form is true

Thanks for submitting!

Crunch & Co. Nutrition and Dietetic Services

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