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Health Declaration
(to be filled up on day of visit only)

(* denotes mandatory fields)

Membership No. (if applicable)
Name: (as in NRIC)*
Contact Number:*
Visiting Locations*

  1. I do not have a fever, cough, sore throat, runny nose and breathlessness.
  2. Neither my family members nor I have been in close contact with any influenza / pneumonia or COVID-19 patient in the past 14 days.
  3. I have not travelled outside of Singapore in the past 14 days.
  4. I have not been in contact with someone currently being issued a Quarantine Order, Stay-Home Notice (SHN) or Leave of Absence (LOA), and have not been issued with a LOA in the last 14 days.
I declare the above information to be true.
I will indemnify and keep indemnified, save and hold harmless, SRC against all loses, claims, demands, actions, proceedings, damages, costs, expenses, including legal fees, and any other liability arising in any way from my entry into the Singapore Recreation Club.
I declare the above information to be true.