COVID-19 PRE-BOARDING HEALTH DECLARATION - GUEST
Full Name:
ID / DOB:
Date:
Ship:
Port:
To protect everyone’s health and safety, please answer the following questions:
1. a) In the 14 days before boarding, have you had any one or more of the following symptoms? YES NO
• Cough
• Shortness of breath
• Dicultybreathing
• Feverorchills
• Newlossoftaste
• Newlossofsmell
b) In the 14 days before boarding, have you had any two or more of the following symptoms? YES NO
• Congestedorrunnynose
• Sore throat
• Muscleorbodyaches
• Extremetiredness
• Headache
• Vomiting
• Diarrhea
2. In the 10 days before boarding, have you tested positive for COVID-19? YES NO
3. Inthe14daysbeforeboarding,wereyouidentiedasaclosecontactofsomeonewithCOVID-19? YES NO
4. In the 14 days before boarding, did you travel internationally? YES NO
If yes: List countries:
5. Areyou,orwillyoubefullyvaccinatedwithaWHOorFDAauthorizedCOVID-19vaccineatleast14daysbeforeboarding?
Fullyvaccinatedisyoureceivedthenaldoseofavaccineseriesatleast14daysbeforeembarkation.
a. Yes
b. No–Iamnotfullyvaccinated,butIhaveaCOVID-19VaccinationExemptionLetter
c. No–Iamnotfullyvaccinated,andIdo nothaveaCOVID-19VaccinationExemptionLetter
Iherebyattestandrepresentthattheanswerscontainedinthishealthdeclarationaretrue,correct,andcomplete.Iunderstandmyresponses
maybereportedtopublichealthauthoritiesandmedicalpersonnelontheshiporashore.Iagreeandfullyacknowledgethatprovidingfalse,
misleading,orincompleteinformationmaycauseorcontributetoanoutbreakandlife-threateningillnesstocertainpersons,andwillsubjectme
topenalties,includingbutnotlimitedto,denialofboarding,disembarkationattherstavailableopportunityatmysoleexpense,quarantine,
suspensionofonboardprivileges,and/ordenialoffuturebookings.Suchdecientinformationmayalsomakemecivillyliableforinjuries
orlossestopersonsonboardtheship,ashore,orinthecommunitiesvisited.Intheeventthatfalseormisleadinginformationisprovided
onthishealthdeclaration,absolutelynorefund,FutureCruiseCreditnorcompensationofanyformwillbeoeredinanycircumstance.I
furtherunderstandandacknowledgethatwillfullyprovidingfalseormisleadinginformationmayleadtocriminalnesorimprisonmentunder
federalstatutes,including18U.S.C.§1001.IacknowledgethatthehealthinformationIprovidewillberelieduponbyship’ssta,medical
personnel,fellowpassengersandcrew,aswellaspublichealthocialsintheU.S.andthedestinationsvisited;thatinaccurate,falseorincorrect
informationcouldcauseorcontributetoapublichealthcrisisandpotentialcivilliabilityforthoseimpacted.Iacceptmyobligationtofully,
accuratelyandtruthfullyprovideallrequestedinformation.
ReadourPrivacyandCookiesnoticehere:https://www.carnivalcorp.com/privacy-notice
SIGNATURE:
FOR OFFICIAL USE ONLY
Validation
Pre-travelCOVID-19testwithin72hoursofembarkationvalidated: Negative Positive N/A DocumentofRecovery
EmbarkationCOVID-19testvalidated:
Negative Positive N/A DocumentofRecovery
COVID-19VaccinationStatusvalidated: FullyVaccinated
NotFullyVaccinated: WithExemption WithoutExemption
Notes:
FormValidated: Name&Position:_____________________________________________ Initial:_______________________
COVID-19Pre-boardingHealthDeclaration-Guest_2021-07-07_Ver2
One form per person must be completed before boarding the ship. All elds are required.On