COVID-19 ATTENDANCE REGISTER
JUST DANCE CAIRNS
Date
*
-
Day
-
Month
Year
Date Picker Icon
Name
*
First Name
Last Name
Phone Number
*
Email
*
example@example.com
Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
Until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
If your visit exceeds your estimated departure time, you will be required to complete a new form for the additional time
*
Yes
In the previous 14 days, have you had any COVID-19 symptoms?
*
Yes
No
In the previous 14 days, have you been in contact with any confirmed/suspected COVID-19 case?
*
Yes
No
In the previous 14 days, have you travelled internationally?
*
Yes
No
Have you downloaded and are using the COVIDSafe app?
*
Yes
No
DISCLAIMER
Just Dance Cairns reserves the right to refuse entry
Submit
Should be Empty: