Lateral Flow Test Check In

First Name(Required)

Surname(Required)

Location(Required)

London

Manchester

Arrival time at the Bayit(Required)

PLEASE USE 24HR TIMES E.G. 13:00

I have not tested positive for COVID-19 in the last 10 days by either PCR or Lateral Flow Test(Required)

I do not have any symptoms of COVID-19 (a high temperature, a new, continuous cough or a loss or change to my sense of smell or taste)(Required)

No one I live with has symptoms or tested positive in the last 10 days(Required)

I have not been in close contact with anyone who has symptoms of COVID-19 since their symptoms started or during the 48 hours before they started(Required)

I have not been told to isolate due to contact with someone who has tested positive in the last 10 days(Required)

By signing this form, you agree that all of the above is entirely true. If found to be untrue, you will immediately forfeit your place on Seenai Machane without refund.

Signature(Required)

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