Clermont Freedom 5k

Sat July 4, 2020 Clermont, FL US 34711 Directions
Declaration of Health

I___________________________________(name of participant, volunteer, staff, vendor) declare that today ____________________(date must be within 2 days of race day) am not infected nor have had or been in contact with someone experiencing any Covid 19 symptoms in the last 14 days prior to July 4th’s Clermont Freedom 5K. Such symptoms may include but not be limited to: cough, shortness of breath, or difficulty breathing, fever, chills, muscle pain, sore throat or new loss of taste of smell. 

I also understand that I was encouraged not to participate in this FloDash 4th of July Clermont Freedom 5K live event if I fall under or live with someone in these categories: 

  • People over 65 years of age
  • People who have chronic lung disease, moderate to severe asthma, or severe heart disease;
  • People who are immunocompromised: those who have undergone or are undergoing cancer treatment, bone marrow or organ transplantation; anyone with immune deficiencies, poorly controlled HIV or AIDS, or had prolonged use of corticosteroids; and smokers;
  • People of any age with class III or severe obesity; or
  • Anyone diagnosed with the following underlying conditions: diabetes, liver disease, and persons with chronic kidney disease undergoing dialysis.

Per executive order from Governor DeSantis, all individuals traveling from Connecticut, New Jersey, New York and Louisiana must isolate or quarantine for a period of 14 days from the time of entry into Florida. Travel from other domestic locations is at the discretion of the individual.


_________________________

Today’s Date


_________________________________________

Last name, First name


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Age on race day

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