IMCC COVID-19 Attendance Register

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In accordance with Government regulations, we require that all members, racers, mechanics and volunteers who enter the facility register their details to assist with contact tracing. Please complete the form below to register your attendance each and every time you attend the facility.

First Name *

Last Name *

Email Address *

Mobile Number *

Declaration *

In the past 14 days I have not been unwell or had any ﬂu-like symptoms ie. fever, cough, sore/scratchy throat, experienced any sudden loss of smell or loss of taste, been in contact with a known or suspected case of COVID-19, been to any of the identified COVID-19 case locations, or have a high risk from a health perspective eg. have pre-existing medical health conditions.

I declare that I am not suffering from any of the symptoms/conditions above

I declare that the contact details I have provided are accurate and correct

Required

COVIDSafe App *

Do you have the COVIDSafe App?

Yes

Required

Submit

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