Health Declaration Form for travelers entering Bonaire

To protect your health and the health of the general public of Bonaire, you are required by the public health department of Bonaire to complete this form. This form allows the public health officers to use your information to contact you when necessary in case of issues with regard to COVID-19. It is important to fill out this form completely and accurately. Your information is intended to be held in accordance with applicable laws and is used for public health purposes only. Thank you for your assistance to protect your health and the health of the general public of Bonaire.
One form should be completed by each person. Parents should complete this form for minors.

Please note! When you travel to Bonaire from a very high risk country you need to undergo a PCR-test on day 5 after arrival. Please fill in the test-willingness statement and bring it with you on your trip in hard copy. This statement is attached to the confirmation email that you will receive after filling in the health declaration form. You can make your test appointment upon arrival on the airport of Bonaire. You can not make an appointment prior to arrival.

The list of very high risk countries can be found on:

Please complete this form between 72 and 48 hours before your departure to Bonaire.
Please print this form after completion and keep it in your hand luggage. You may be asked to show this during your journey by a public health officer.

Seat row and letter: please note the row number and letter of your actual seat during the flight on your phone or a paper and save this for a minimum of 14 days after your trip.

Arrival date on Bonaire
Bonaire Resident
Departure date leaving Bonaire
Personal And Contact Information
Emergency Contact Information
Health Information

Do you have any of the following symptoms at this moment?
Please check the box if the answer is yes

Have you been in contact with a confirmed case of COVID-19 in the past 14 days?

In which countries, or on which island, have you stayed during the past 14 days?
You are obliged to mention here all the countries or islands where you have been during the past 14 days. (Multiple answers are possible by pressing +)

Do you have a medical or travel insurance, that covers COVID-19 related issues? (Note: Bonaire residents are insured via ZVK, and can answer this question with yes)

Did you do a COVID-19 PCR test within 48 hours of your departure?

If you did a COVID-19 PCR test: what was the result?

Have you been vaccinated?

If so, with which vaccine?

And on what date/dates were you vaccinated?

Take your proof of vaccination with you when traveling.

Sign, Print and Send

I am a parent/guardian and completed this form on behalf of a minor: