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Urban Fresh Vegetarian Kitchen

Urban Fresh – COVID-19 Health Checklist

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Name*
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Age*
Gender*
Contact No.*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Temperature*

Are you experiencing any of the following:
Sore throat*
- Yes
- No
Headache*
- Yes
- No
Body Pain*
- Yes
- No
Fever*
- Yes
- No

Were you exposed to:
A person infected with COVID-19 in the last 14 days?*
- Yes
- No
Someone with fever, cough, colds, sore throat in the last 14 days?*
- Yes
- No

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 Urban Fresh Vegetarian Kitchen 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.
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Live through “valued moments” in our Elegant, Magnificent, First-class Pillarless Function Rooms.

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Corner Aguinaldo and, Raymundo St, Subic Bay Freeport Zone, 2200

hotelinquiry@subicbaytravelershotel.com

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