Member/Guardian Health Self-Declaration

會員/監護人健康申報表

Dear Sir/Madam 尊敬的先生/女士

As a precautionary measure to reduce the risk of exposure of our members/guardians to the COVID-19 situation, we would appreciate if you complete this form. Your participation is important to help us take precautionary measures to protect you and everyone in the Club. Thank you for your time.

為減少我們的會員/監護人在新型冠狀病毒下受感染的風險，作為一項預防措施，請你填寫此健康申報表。你的配合對幫助我們採取適當措施保護會所內的所有人非常重要，感謝你的寶貴時間。

Member's Name 會員姓名: *

Membership No. 會員號碼: (e.g. A1234BC) *

SELF-DECLARATION 健康申報

1. Are you currently having a fever or any flu symptoms such as coughing, runny nose, sore throat? 你目前有沒有發燒或其他流感病徵，如咳嗽、流鼻水、喉嚨痛？ *

Yes 有
No 沒有

2. Have you been in close contact with any confirmed COVID-19 patient in the past 14 days? 你在過去14天內，曾否與任何確診新型冠狀病毒的患者有密切接觸？ *

Yes 是
No 否

Checkboxes *

I hereby declare that all information given above is correct and accurate, and to the best of my knowledge. 本人特此聲明，上述提供的資料為本人所知悉的範圍內及準確無誤。

Providing false or misleading information to club management will be subject to disciplinary action not limited to suspension or loss of membership. We are collecting personal data for the purposes of enabling us to carry out contact tracing and other response measures, with regards to any emergency that may arise due to COVID-19 that may threaten the health or safety of other individuals. The Club reserves the right to refuse entry to any person who has selected “Yes” to any of the above questions.

向會所管理層提供虛假或誤導性信息有機會會受到紀律處分，不僅限於暫停或失去會籍。為應對新型冠狀病毒有機會引起的緊急情況，可能會威脅其他人士的健康或安全，我們正收集個人數據，以便進行追踪及其他跟進措施。會所保留權利拒絕以上任何一條問題回答[有/是] 的人士進入會所。

Name