Health Declaration Form

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Please fill in the form completely and accurately. One form per guest is required to complete check in.

In compliance with the IATF guidelines during the community quarantine, minors and senior citizens are not allowed in the resort.

Email *

Untitled Title

Fullname *

Last Name, First Name Middle Name

Nationality

Sex *

Female

Male

Age *

Contact Number *

Present Address (City Only) *

Have you visited, worked or transited through foreign countries in the past 14 days? If yes, where? *

Please list cities in the Philippines you have worked, lived or transited in the past 14 days *

Have you been sick in the past 30 days? Hospital visited, if any? *

Yes. If "Yes", please describe condition on "Other" field

Other:

Do you have any of the following symptoms? *

Cough

Shortness of Breath or Chest Tightness

Nasal Congestion / Runny Nose

Myalgia (Body Aches)

Loss of Taste and / or Smell

Diarrhea

Nausea

Vomiting

Fever / Chills / Sweats

None

Required

In the last 14 days, have you been in close contact or exposed to any suspected of or confirmed with COVID-19? *

Yes

Other:

In the last 14 days, have you been in close contact with farm animal or exposed wild animals? *

Yes.

Other:

Declaration and Data Privacy Consent Form: *

The information I have given is true,correct, and complete. I understand that failure to answer any question or giving false answer can be penalized in accordance with law. I voluntarily and free consent to the collection and sharing of the above personal information only in relation to the resort's COVID-19 internal protocols.

Required

Please be advised that the above information shall only be used in relation to the resort's COVID-19 internal protocols in accordance with the Data Privacy Act. For any concerns, kindly contact us at gs@aquaria.com.ph *

YYYY

A copy of your responses will be emailed to the address you provided.

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