Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Declaration 1 *

Please confirm you are not showing symptoms of Covid-19 (high fever, a new continuous cough)

Declaration 2 *

Please confirm that you are not in the “high risk” category with underlying health conditions

Declaration 3 *

I agree to inform the Gurdwara Management team if I show signs of COVID19 or come into contact with someone who shows signs of COVID19 symptoms.