Covid-19 Check In

Thank you for visiting The Meeting Place Café. During Covid-19 the Queensland government requires that we retain contact details of all dine- in customers for contact tracing purposes. The information supplied in this form will not be used for any other reasons. Please be truthful in supplying this information.

* Indicates required field

Name *

First

Last

# of dependents with you today *

Phone Number *

Email *

Address (only required if you don't have an email address.) *

Line 1

Line 2

City

State

Zip Code

Country

Are you currently experiencing any of the following symptoms? (i.e. first developed in the last 7 days) Symptoms: Loss of smell, loss of taste, cough, sore throat, fatigue, aches and pains, shortness of breath, runny or stuffy nose, headaches or raised temperature. *

Yes No

Which event are you attending? *

Submit

Covid -19 Customer Check- In