COVD-19 Health Checklist

Instruction: Kindly fill up necessary information.
* All fields are mandatory.
Name*
First Last
Age*
Gender*
Contact No.*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Temperature*

Did you travel:
Abroad in the last 14 days?*
- Yes
- No
Travel to Metro Manila in the last 14 days?*
- Yes
- No
Consent*
I agree to the privacy policy.
I hereby authorize Subic Bay Travelers Hotel and Event Center to collect and process the data indicated herein for the purpose of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA10173, and that I am required by RA11469, Bayanihan to Heal as One Act, to provide truthful information.
Name
This field is for validation purposes and should be left unchanged.

Instruction: Kindly fill up necessary information.