demi's place B&B Registration FORM
Guest No. 1
*
First Name
Last Name
Guest No. 2
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Vehicle License Plate No.
*
Phone Number
*
-
Area Code
Phone Number
Check-in date
*
-
Month
-
Day
Year
Date
Check-out date
*
-
Month
-
Day
Year
Date
Please add any dietary restrictions and or allergies.
*
PAYMENT OPTIONS
*
Credit Card Number
Expiration Number
CVC code
Signature
*
Use mouse on (desk top comupter) or finger (on mobile) to sign .
COVID-19 Health Questions
Have you or the person traveling with you, experienced fever, cough, shortness of breath, difficulty breathing, soar throat, difficulty swallowing decrease or loss of taste or smell, chills, headaches in the past 2 weeks.
*
NO
YES
Have you or the person traveling with you had close contact with anyone with a confirmed case of COVID-19 in the past 2 months.?
*
Yes or NO.
Have you and your traveling partner been fully vacinated for Covid-19
*
YES
NO
Please explain if your answer is NO.
Submit Consent Form
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