COVID- 19 Contact Tracing Register

COVID-19 SALAAH REGISTRATION FORM
Please complete this form to register for salaah, when you arrive at the mosque wash hands with hand sanitiser.
Name

First NameMiddle NameLast Name
D.O.B

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
As per government regulation people under the age of 13 and over the age of 65 are not allowed to attend prayers.
Gender
National I.D/Passport No (Under 18 indicate N/A)
Phone Number
Nationality
Other Nationality Specify
Email
example@example.com
Estate
Street
County
Next of Kin Details

First NameLast Name
Phone Number
Email (optional)
example@example.com
Have you had COVID-19 symptoms in the last 14 days?
Take Photo (Optional)
Upload Image (Optional)

Browse Files

Cancelof
Upload Image (Optional)
Kindly accept Terms and Conditions as per government regulation. Please consent parklands Mosque to send you information on the mosque activities and Dawah.
Temperature Check
Personal Pin identification
Should be Empty: