Burger King De Lucht

N270

Please fill out the details below for the visitor registration that we are obliged to offer by the Rijksoverheid/RIVM

Your name

Your phonenumber

Your e-mail address

How many people are on your table?

Healthcheck
Did you suffer from one or more of these complaints (during the last 24 hours)?

Sneezing
Coughing
Fever over 38 degrees Celsius
Shortness of breath

At this moment, do you have a housemate with fever and/or shortness of breath?
Did you suffer from the new coronavirus and was this determined during the last 7 days (in a lab)?
Do you have a housemate or familymember suffering the new coronavirus and did you stay in contact with him/her during the last 14 days while he/she still had complaints?
Concerning your visit to us: is your group completely one household?