Health Declaration Form

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As per government directives, our dine-in guests are required to submit this form for contact-tracing purposes. Please provide accurate information.

We will politely decline service to those with Covid-19 symptoms and those who could have been exposed to potential cases. Thank you for your understanding.

I CERTIFY THAT:

• I have not had Covid-19 symptoms in the last 14 days.
• I have not had contact with a Covid-19 patient or potential Covid-19 exposure in the last 14 days.

Name *

Mobile number *

Terms of Agreement *

I authorize Sensei to collect and process my personal information for Covid-19 contact-tracing purposes. I understand that my data is protected by R.A. 10173, the Data Privacy Act, and that I am required by R.A. 11469, the Bayanihan to Heal as One Act, to provide truthful information.

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