COVID 19 Declaration

COVID 19 Declaration Form

Confirmation Needed *

I/we have not returned from overseas in the past 14 days Are not required to be in self-quarantine Have not been in contact with a person who has been confirmed with a case of COVID-19 in the past 14 days I/we have not had a fever, cough, sore throat, shortness of breath or other cold/flu-like symptoms in the last 72 hours and I am/we are otherwise well and can confirm we have not been in a restricted hotspot zone in the last 14 days.

Primary Contact Name *

Cabin / Site Number *

Email *

Phone Number *

List of People to Declare

Please provide the below details of everyone that will be coming on this trip, including children.

Full Name *

Age *

Adult

Child Under 16

Email *

Phone Number *

Vaccinated

First Shot

Yes

Add Remove

Vehicle Details

Please provide a list of every Vehicle, Boat and Trailer that is registered with their Access Code.

Vehicle Plate Number *

Access Code *

Boat Rego Number

Trailer Rego Number

Add Remove

Trip Details & Sign

Please enter the dates you intend to make this trip. Todays date will be included as the time stamp of your declaration. If you have to make any changes to the information entered in this form, please get back to the park before you leave to ensure no hold ups.

Trip Start Date *

Trip End Date *

Travelling From

Suburb & State you are travelling from

Signature *

Clear

Reception Hours

7 DAYS
8:30am – 5:00pm
Hours may be extended during Peak Season

CHECK-IN
2:00pm
CHECK-OUT
10:00am

10 Eildon Road, Eildon VIC 3713

PO Box 181, Eildon VIC 3713

Phone: 03 5774 2105

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Eildon POndage Holiday Park

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COVID 19 Declaration

List of People to Declare

Vehicle Details

Trip Details & Sign

Reception Hours

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