Name and Surname (required)

Patron Number/ID Number (required)

1. Have you or any of your immediate family or persons sharing the same residence as you, been diagnosed with COVID-19 in the last 10 days?(required)
YesNo

2. Have you had close immediate contact with or cared for someone diagnosed with COVID-19 within the last 10 days?(required)
YesNo

3. Are you experiencing any of the following symptoms: fever, loss of taste and smell, cough, sore throat, difficulty breathing, redness of eyes, or similar COVID-19 related symptoms?(required)
YesNo

Declaration*

By checking the box below, I hereby declare that:

The information provided is to the best of my knowledge accurate, truthful & correct in all respects, and I have not omitted to disclose any information.

I shall immediately notify a security representative at the property of any change relating to the information provided which may occur during the course of my visit to the property.

I consent to my personal information being provided to the requisite regulatory authority for the purposes of contact tracing relating to the prevention of the spread of the Covid-19 virus.

Given the nature of the Covid-19 virus, I know & understand the risks of exposure to the virus that may occur at the property & agree that I cannot hold GR Concept, its subsidiaries, associated companies, directors, managers, employers and contractors (“the indemnified parties”) liable for the transmission of or any outbreak of the virus at the property. I hereby indemnify and waive any right that I may have to institute any claim against the indemnified parties in relation to the Covid-19 virus and/or the contraction thereof.

And that this consent and indemnity is given of my own free will.

Male/Female (required)
MaleFemale

Sandal Size - EU (required)
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Accept