Health Declaration & Contact

Please fill out the following health declaration form in order to dine in our restaurant. We pledge that your information will only be used to contact you in the event of possible contact with confirmed covid case.

First Name

Last Name

Phone

My body temperature is lower than 98.6°F/ 37.5°C

Select time of visit

19:12

Date

I confirm that the information given in this form is true

Thanks for submitting!