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Name
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Last
NATIONALITY
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COUNTRY
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ADDRESS
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CITY
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TRAVEL DOCUMENT
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E-MAIL
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MOBILE PHONE NUMBER
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BIRTHDATE
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ACCOMPANY NAME
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ACCOMPANY LAST NAME
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Our check in time is from 15:00, we would like to know your arrival time:
check in
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Our check out time is until 12:00, we would like to know your departure time:
Check Out
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During your stay, will you require cleaning service in your room?
CLEANING SERVICE
*
Yes
No
Have you, or any of your companions, been in contact with anyone diagnosed positive covid?
Been in contact Covid19
*
Yes
No
Have you been sick or sick the last 30 days?
Sick the last 30 days?
*
Yes
No
Were you in contact with any person ill with Corona Virus (Covid-19)?
contact with any person ill (Covid-19)
*
Yes
No
Were you ill during your stay abroad over the last 30 days?
last 30 days ill?
*
Yes
No
WHAT ILLNESS?
*
DATE OF FIRST SYMPTOMS
*
Do you currently have any of these symptoms?
COUGH
*
Yes
No
FEVER
*
Yes
No
MUSCLE PAIN
*
Yes
No
DIFFICULT BREATHING
*
Yes
No
RUNNY NOSE
*
Yes
No
HEADACHE
*
Yes
No
SKIN RASH
*
Yes
No
Sore Throat
*
Yes
No
NAUSEA - VOMITING
*
Yes
No
JOINT PAIN
*
Yes
No
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