Name Surname E-mail Phone Year of Study ---1ˢᵗ Year of Study2ⁿᵈ Year of Study3ʳᵈ Year of Study4ᵗʰ Year of Study5ᵗʰ Year of Study6ᵗʰ Year of Study Study Programme ---Animal ScienceGeneral Veterinary MedicinePharmacyPostgraduate study (PhD.) AIS ID Country of Arrival: ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBritish Virgin Is.BruneiBulgariaBurkina FasoBurmaCameroonBurundiCambodiaCanadaCape VerdeCayman IslandsCentral African Rep.ChadChileChinaColombiaComorosCongo, Dem. Rep.Congo, Repub. of theCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambia, TheGaza StripGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Fed. St.MoldovaMonacoMongoliaMontserratMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaN. Mariana IslandsMoroccoNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts & NevisSaint LuciaSt Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin IslandsWallis and FutunaWest BankWestern SaharaYemenZambiaZimbabwe 1. Today or in the last 14 days, I do not show any symptoms of a viral infectious disease (e.g. fever, cough, difficulty breathing, muscle pain, headache, tiredness, malaise, sudden loss of taste and/or smell, etc.) ---Yes, I showNo, I do not show 2. In the last 14 days, I am unaware that I have come in contact with a person who has been diagnosed with COVID-19 or is suspected of having COVID-19 ---Yes, I have comeNo, I have not come 3. In the last 14 days, I have not attended a mass event with more than 100 people or event with international participation ---Yes, I have attendedNo, I have not attended You are obliged to monitor your health, the health of people living in the same household and other close people with whom you are in frequent contact, and in case of symptoms, you are obliged to proceed in a specified manner. 4. In the last 14 days, I have not visited or arrived from a country which, in accordance with the valid measure of the Public Health Care Authority of the Slovak Republic, is marked as high risk country ---Yes, I have visited/arrived fromNo, I have not visited/arrived from 5. I have no obligation and for the last 2 months, I have not had an obligation to remain in quarantine ---Yes, I have/I have had the obligationNo, I have not/I have not had the obligation I solemnly declare that in order to maintain public health in the coming period I will behave responsibly, refrain from risky activities, limit travel as much as possible (also within the Slovak Republic) and I will follow the instructions of the University of Veterinary Medicine and Pharmacy in Košice published on its website and/or at it premises, under which the university operates. I am aware of the legal consequences if this statement is not true. As you have answered Yes in the paragraph 4 and/or 5, you are obliged to submit scan of a negative result of the PCR test for COVID-19, which was performed in the Slovak Republic in accordance with the valid measures of the Public Health Care Authority of the Slovak Republic, or you are obliged to submit a scan of a decision of the Public Health Care Authority of the Slovak Republic on the termination of quarantine. At the same time, you declare that you have not visited a high risk country repeatedly since the date of receiving the negative result of the PCR test for COVID-19 disease.