Sign In Form・チェックイン
Please Sign-in using this form for every visit.
毎回お越しの際にご記入して頂きます。
Last Name (苗字) *
First Name (下のお名前) *
Birth Month (生まれた月) *
Please 『Choose』month of your Birth from below
COVID-19 Screening Questionaire
Covid-19 Screening Questionnaire *
Yes
No
Received at least the first dose of the vaccine?
Have you been in close contact with anyone who has a confirmed COVID-19 diagnosis within 14 days?
Submit
Never submit passwords through Google Forms.
This form was created inside of Weebly Email Service. Report Abuse