Reservation form - WestCord Hotels

Name*

Salutation First name Last name

Email address*

Enter email address Confirm email address

Phone no.*

Adress*

Country*

Identification type*

Identification number*

Date of birth*

Nationality*

Gender*

Male
Female
Prefer not to answer

Have you (or anyone in your group) had one or more of the following symptoms in the past 24 hours; cough, cold, fever of at least 38 degrees or shortness of breath?*

Yes
No

Do you (or anyone in your group) live with someone who currently has a fever and/or shortness of breath?*

Yes
No

Have you (or anyone in your group) had the coronavirus and has it been diagnosed in the last 7 days (in a lab)?*

Yes
No

Do you (or anyone in your group) have a family member/housemate with the coronavirus and have been in contact with them during the past 14 days while he/she still had*

Yes
No

In the past 14 days, have you (or anyone in your group) been in contact with a family member/ housemate who had the coronavirus while he/she still had symptoms?*

Yes
No

Are you (or anyone in your group) in quarantine because you have had direct contact with someone who has been diagnosed with the coronavirus?*

Yes
No

CAPTCHA