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 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 4. 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 5. In the last 3 months, I have overcome COVID-19 diseases, attested by a certificate ---Yes, I have overcome COVID-19No, I have not overcome COVID-19 6. I was vaccinated against COVID-19 disease also with a second dose of the vaccine and at least 14 days have elapsed since this vaccination, attested by a certificate ---Yes, I wasNo, I was not 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 at least one of the the paragraphs 4, 5 and/or 6, you are obliged to submit one of the following documents: - 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 an offcial decision on the termination of the quarantine, while at the same time, you declare that you have not visited a risky country repeatedly since the date of receiving the negative result of the PCR test for COVID-19 disease - scan of an official confirmation of overcoming COVID-19 disease within the last three months - scan of confirmation of being vaccinated with a second dose of the vaccine, if at least 14 days have passed since its application
