COVID-19 Guest Declaration Form

To protect the health and well-being of everyone in Lake Hume Resort and prevent the spread of COVID-19 in the resort and our community, you must complete this Declaration Form pre-arrival to confirm your recent travel, health status and contact details (as well as recent travel, health status and contact details of any persons accompanying you). We may provide this information to the NSW Health Authorities if necessary for contact tracing purposes.

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I CONFIRM

I/we have not returned from overseas in the past 14 daysI am/we are not required to be in self-isolation/self-quarantineI/we have not previously been diagnosed with COVID-19To the best of my knowledge, I/we have not been in close contact with a person who is suspected or confirmed case of coronavirus (COVID-19) in the past 14 daysI/we have not had a fever, cough, sore throat, shortness of breath or other cold/flu-like symptoms in the last 72 hours and I am/we are otherwise wellI/we confirm we are not from Melbourne

Primary Contact Details

Full Name

Phone Number

Street Address

Suburb

Vehicle Registrations

Vehicle Registration Number

Trip dates

Arrival

Departure

Date of Signing

Date

Emaila valid email

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COVID-19 Guest Declaration Form