Corona Virus (COVID-19) Declaration - Port Gregory Caravan Park

Corona Virus (Covid-19) Decleration

In the interest of protecting the health and well-being of our guests and staff, prior to you Port Gregory Caravan Park, we are required to ask you questions related to your travel and health activities.

We ask that you are honest and take your share of responsibility when responding to the following questions, so that we can all do our best to prevent the spread of COVID-19 in the park and our community.

Due to state and federal restrictions associated with the coronavirus COVID-19; please read and complete the following acknowledgements.

Your Name*
Arrival Date*
DD slash MM slash YYYY
Departure Date*
DD slash MM slash YYYY
I acknowledge that*
- I/We have not returned from overseas in the past 14 days
- I/We am not required to be in self-isolation/self-quarantine
- I/We have not previously been diagnosed with COVID-19
- To the best of my knowledge, I/We have not been in close contact with a person who has a reported or suspected case of coronavirus (COVID-19) in the past 14 days
- I/We have not been in a COVID-19 hotspot (as defined by the Chief Health Officer) in the past 14 days
- I/We have not had a fever, cough, sore throat, shortness of breath or other cold/flu-like symptoms in the last 72 hours and are otherwise well
If you answer yes to any of these questions you may be referred to a local health authority or the police
Please provide details of all locations visited and accommodation details for the past 14 days
Please list each location visited (include name & address) and list the number of days stayed at each location*
This information is for contact tracing purposes should it be required and may be shared with Police or Health officials if requested.
Please provide details of details of your next location and accommodation. (Please include name & address of accommodation and number of days you intend to stay)*
This information is for contact tracing purposes should it be required and may be shared with Police or Health officials if requested.
Listed Parties. Please list all persons (adults and children) covered by this declaration
Person 1*
Person 2
Person 3
Person 4
Person 5
I/We agree to comply with all social distancing measures, good hygiene practices and park rules. I/We declare that the answers I have provided above are true and accurate for myself and all the listed parties who are residing with me
Signature*
By signing here you agree to the terms of this agreement and I agree that my typed name below can be used as a digital representation of my signature to that fact.

Corona Virus (Covid-19) Decleration

Please provide details of all locations visited and accommodation details for the past 14 days

Listed Parties. Please list all persons (adults and children) covered by this declaration