Spin Driving School Covid -19
Self Assessment Form
Name *
First and last name
Email *
Phone number *
Home Address *
Have you been to one of the COVID-19 affected countries in last 14 days? *
Required
Have you been in close contact with a confirmed case of COVID-19? *
Required
Are you currently experiencing symptoms (cough, shortness of breath, fever) *
Required
Signature *
By submitting I hereby confirm that the information i have given above is true, and that i will comply with the terms and conditions outlined by Commonwealth Department of Health.
MM
/
DD
/
YYYY
Time
:
Submit
Never submit passwords through Google Forms.
This form was created inside of AEON SOFTWARE. Report Abuse