Health Declaration Form

The Club is committed to providing a safe environment for our Members, customers and staff.

Instructions:

  • Each Member or guest is required to submit the e-health declaration form once for each Club premises per day.
  • Upon submission you will receive a SMS confirmation.
  • Please show the SMS confirmation to our staff upon arrival at the reserved venue.
  • You will not be allowed into the Clubhouses or Racecourses if you fail to complete this form or confirm the matters as set out in this form.
  • Members are encouraged to share this e-Health Declaration form to their invited guests for the convenience of completion in advance of arrival.

We appreciate your cooperation.

A. Details of Visit

Date of Visit:*(DD/MM/YY)
Location:*
Reserved Venue:*
Mobile Number:*
Country Code
Mobile Number*
For Members ONLY
Membership Number:*
For Non-Members ONLY
Name (as appeared on ID document):*
Name of Host Member:
Year and Month of Birth (as appeared on ID document):*
Gender:*
Male
Female
Residential Address*
Room / Unit / Flat and Floor:
Building Name / Block:
Estate and Phase:
Street Number:
Street Name:
District:

B. Declaration

I hereby declare and agree that:
  1. I do not have and have not had within 14 days prior to the date of visit any of the common symptoms of Coronavirus Disease 2019 (COVID-19) – such as fever, malaise, dry cough, shortness of breath, nasal congestion, headache, conjunctivitis, sore throat, diarrhoea, loss of taste or smell, skin rash or discolouration of fingers or toes.
  2. I am not currently subject to any quarantine order issued by the Government.
  3. I have not been in close contact with any person who has travelled outside Hong Kong and is currently subject to a quarantine order issued by the Government, in particular family members, helpers or drivers.
  4. I have not been in close contact with any person who is a confirmed or preliminary positive case of COVID-19 infection in Hong Kong or overseas within 14 days prior to the date of visit.
  5. I do not live in a building in which there has been a confirmed case of COVID-19 within 14 days prior to the date of visit as published by the Centre for Health Protection.
  6. I am not required to undergo COVID-19 testing pursuant to a compulsory testing notice or direction / I have undergone COVID-19 testing pursuant to a compulsory testing notice or direction and the result is negative.
  7. If this form is submitted prior to the day of my visit, I should notify the Club of any change in circumstances prior to or at the time of my visit.
  8. I understand that Members are also responsible for the declaration of their guests and family members. Any Member or guest who knowingly makes a false declaration will be considered to be in serious breach of Club rules.
“Close contact” generally means having direct physical contact, living in the same household, travelling in the same vehicle or flight, having social contact in close proximity such as dining together. The above examples are not exhaustive. If you are in doubt, we advise that you err on the side of caution and refrain from using Club facilities.
IMPORTANT: Any Member who knowingly provides false or misleading information is in serious breach of the Club rules and could be subject to disciplinary action by the Club. Members are also reminded that they are responsible for the actions of their guests.

  • I confirm that the above information is accurate to my best knowledge and agree that such information will be processed and used in accordance with the Club’s Privacy Policy Statement, including the facilitation of any contact tracing or other work in controlling the spread of COVID-19 and related purposes.

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