CULTURAL SOCIETY

Varnam

WELCOME TO

Varnam Cultural Society Queensland Covid Safe check-in form

First Name

Last Name

Email

Phone

By submiting this form you are also confirming that you (and any dependants listed above):

Have not travelled overseas within the last 14 days;

Are not showing signs and symptoms of COVID-19 (fever, flu like symptoms such as coughing, sore throat or headaches; or having difficulty breathing;

Have not had close or casual contact with a person who has been confirmed with COVID-19;

Every person listed on this form must be able to be contacted via the phone number or email address provided. If not, please complete another form for them listing their alternative contact details.

Thanks for submitting!

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Chithirai Kalai Vizha 2019

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Karthigai Dheepam 2019

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Chithirai Kalai Vizha 2018

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Karthigai Dheepam 2018

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Email : Varnamqld@gmail.com

Phone : Rajarajan Thennavan – 0431 433 889

CULTURAL SOCIETY

Varnam

WELCOME TO

Varnam Cultural Society Queensland Covid Safe check-in form

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