Please fill in this form 1 to 2 days before you are due to arrive Please complete and submit this form 1 to 2 days before you are due to arrive and by 2pm of the day before arrival at the latest. For example, if you are arriving on a Friday, please fill in this form on Wednesday or by 2pm on Thursday at the latest. Please don’t complete the form earlier than this - thank you. If you need help completing this form online, you can phone the office and we will read and fill in the form for you while you are on the phone. We have a legal requirement for NHS Test & Trace to get the name and contact details individually for all our guests who are 16 years old or more. Please can each person who is aged 16 or over complete this form with their own details.Arrival Date* DD slash MM slash YYYY Name of person aged 16 or over* First name Surname Contact email address* Contact phone number*How many children under 16 are you also declaring for?Please enter a number from 0 to 5.Name of first child* First name Surname Name of second child* First name Surname Name of third child* First name Surname Name of fourth child* First name Surname Name of fifth child* First name Surname NHS Test & Trace*In order for you to visit, we are legally required to get your consent to use your contact details, if needed, to support the NHS Test and Trace programme. In line with guidance issued by the Department for Health and Social Care, we will keep your details from this form safely and in compliance with GDPR legislation for 21 days after your visit, before securely disposing of or deleting them. We will only share your details with NHS Test and Trace, if asked, in the event that it is needed to help stop the spread of COVID-19. I agree to my data being used for NHS Test and Trace and for the any children I am also declaring for.Pre-visit Declaration*To help take care of each other, we need you to answer the questions below for yourself and any children you are also declaring for. You need to let us know straight away between now and your arrival if any of these answers change for you or any of the children you are declaring for. As we are sure you would understand, unfortunately anyone for whom any of these questions are true will not be able to visit. 1. Do you currently have, or have you experienced in the last 10 days, any of the COVID-19 symptoms below, even if only mildly? (a) a new continuous cough (b) a high temperature (37.5ºC or higher) (c) a loss of, or change in, your normal sense of taste or smell 2. Have you felt physically unwell with any other symptoms in the last 10 days? 3. Have you had any close contact with, or cared for, someone diagnosed with or suspected of having COVID-19 within the last 10 days? 4. Have you travelled back from a red or amber list country in the past 10 days? (You can answer No if you have successfully completed the Test to Release scheme). 5. Have you been in close contact with anyone who has travelled back from a red or amber list country in the past 10 days? (You can answer No if they have successfully completed the Test to Release scheme). I confirm that I can answer NO to all the above questions for myself and any children I am declaring for. I agree to contact Scargill straight away between now and my arrival if any of these answers change for me or any of the children I am declaring for.Lateral Flow Device testing Between visits from different groups of guests, all community members will take a Lateral Flow Device test. As part of taking care of each other, we would strongly encourage you also to take a Lateral Flow Device test the day before or on the day of your visit before arrival. If your test result is positive, you should not come on your planned visit to Scargill. Lateral Flow Device test kits are available free of charge in the post within 1 to 2 days of ordering. Kits can be ordered from https://www.gov.uk/order-coronavirus-rapid-lateral-flow-testsCoronavirus Arrangements We have put in place a range of measures to help us appropriately implement, to the specific setting of Scargill, the current coronavirus guidelines from the Government. These arrangements are outlined in a Guest Summary called “Taking Care of Each Other”. There is also a detailed Operational Version of the Risk Assessment, which contains further information divided into different sections. When you submit this form, you will also receive a copy by e-mail.