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Declaration of passengers to prevent spread of COVID-19


Measures taken for your safety




Review and sign the statement using your name as your signature


Disclosure and Attestation of the passenger to the United States of America


Check one of the boxes that applies:


 I  attest that I have received a negative pre-departure test result for COVID-19. The test was a viral test that was conducted on a specimen collected from me during the 3 calendar days preceding the flight’s departure.


 I  attest that I have recovered from COVID-19 in the last 3 months (90 days), or the time period specified in current CDC guidance, after having previously tested positive for SARS-CoV-2 and have been cleared for travel by a licensed healthcare provider or public health official.


For being the passenger under 18 years of age or having a disability that allows them to complete this form I

, on behalf of

, stated:



 That such person has received a negative pre-departure test result for COVID-19. The test was a viral test that was conducted on a specimen collected from that person during the 3 calendar days preceding the flight’s departure.


 That such person has recovered from COVID-19 in the last 3 months (90 days), or the time period specified in current CDC guidance, after having previously tested positive for SARS-CoV-2 and has been cleared for travel by a licensed healthcare provider or public health official.