ShareTravel & Health Declaration FormIn view of COVID-19 situation in Singapore, X-Trekkers is taking precautionary measures by seeking your co-operation to complete the following travel & health declaration. Please indicate if you have/have not travelled outside of Singapore within the past 14 days.If you are feeling unwell or serving Stay Home Notice (SHN)/ taking Leave of Absence (LOA), we will postpone your participation without any penalty.Kindly submit your travel declaration within 2 working days from receipt of this notification. * Required1. What Event Are You Attending?*2. Event Start Date*3. Full Name (as in NRIC/ PASSPORT)*4. Last 3 digits and 1 letter of NRIC No (SXXXX123A) / FIN No (GXXXX123A) / Passport No (for Foreigners) *5. Contact Number AND Email Address (For contact tracing)* 6. Have you travelled outside Singapore within the last 14 days?*YesNo7. If "yes" to Question 6, please specify the countries and cities that you have visited.8. Have you been issued a Stay Home Notice or taking Leave of Absence in the past 14 days?*YesNo9. If yes to Question 8, please indicate the period of SHN or LOA <dd/mm/yyyy to dd/mm/yyyy>10. In the past 14 days, I have come in close contact with someone who is:*A COVID-19 confirmed case?Under Stay Home Notice (SHN) or Leave of Absence (LOA)None of the above11. Are you feeling unwell currently? (E.g Fever, cough sore throat, runny nose & breathlessness) **YesNoI hereby declare that the above information provided is to the best of my knowledge and this is a truthful declaration. (The information you provide is important in managing the risk of COVID-19 transmission. The Infectious Diseases Act requires a person who has reason to suspect that he is a case or carrier of COVID-19, or has had contact with a person with COVID-19, to act in a responsible manner to not expose other persons to the risk of infection by the disease.) **YesNoCAPTCHANameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.