you have normal temperature

Contact Information:

Contact Number

Address:

Are you currently experiencing any type of the following symptoms: Fever, Sore throat, Diarrhea, Shortness of breath.

YesNo

You have a fever

we apologize however due the government mandated GCQ guidelines, anyone with symptoms that fall under... will not be allowed entry at our store.

Declaration and Data Privacy Consent
The information I have given is true, correct, and complete. I understand that failure to answer any question or giving false answer can be penalized in accordance with law. I voluntarily and freely consent to the collection and sharing of the above personal information in relation to RCOC COVID-19 internal protocols and for the purpose of affecting control of the COVID-19 infection as required by R.A. 11469, Bayanihan to Heal as One Act.