Entry Form

Entry Registration

All your personal data is held in accordance with POPIA and GDPR privacy regulations. View privacy policy for details. Your data is not shared with any third party and will be used to process your reservation and send you notification relating to your stay.

*First Name

*Last Name

*Email

*Phone Number

*Passport/ID Number

*Entry Date

Covid 19 Regulation Checks

Please answer the follow questions truthfully regarding your health over the past 2 weeks. A cough is classified as any cough more than 3 times over a 24 hour period.

*Current Temperature Reading

*Are you feeling generally well?

*Recent or current cough?

*Recent or current fever or chills?

*Recent or current sore throat

*Recent or current shortness of breath?

*Recent or current loss of, or change in,sense of smell or taste

Covid 19 Travel Questions

*Have you travelled internationally in the past 30 days?

Yes

To Which Country/s?

Departing on which date?

Returning from which country?

Returned on which date?

In the past 14 days, to your knowledge, have you been in close contact with anyone who tested postitive for COVID 19 or is waiting for test results?

*Have you have any possible Covid 19 contact recently?

Yes

Possibly

*Are you medically "at risk" if you get Covid-19?

Yes

Please explain risk factors or medical conditions

If you have visited a medical healthcare facility like a hospital, doctor or clinic in the past 14 days and they treat or test active or suspected Covid-19 patients then please confirm the following.

*Have you visited any healthcare facilities recently?

Yes

*Are you waiting for test results for any Flu, Cold or Covid-19 symptoms?

Yes

Home Address

*House Number

*Street Name

*Town

*Post Code

*Country

Terms and Conditions

* All rooms are strictly NON-SMOKING - A cleaning fee will be levied for non compliance.
* Glen Avon cannot be held liable for any injuries, illness, damages or losses to any person or belongings.
* Please note that due to Covid-19 our guest laundry service is currently unavailable.
* Glen Avon adheres to GDPR regulations and by signing this form you also agree to email correspondence with regards to matters relating to your booking.

By signing this form you hereby confirm that you agree to the above terms and conditions.
And that all information you have provided in this multi page form is true and correct to the best of your knowledge.

*Signature

Entry Registration

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