Llafranc (Girona)
T. +34 620 53 00 36
diving@tritonllafranc.com

COVID-19 Form

COVID-19 RESPONSIBLE STATEMENT
Date of declaration of this form:

Personal information

Have you had or felt or someone around you? (You must answer all questions):
Temperature above 38° C: YesNo
Chills: YesNo
Discomfort: YesNo
Severe fatigue: YesNo
Unusual headaches: YesNo
Sore throat: YesNo
Nose cracking or sputum: YesNo
Loss of taste and/or smell: YesNo
Loss of appetite: YesNo
Chest pain: YesNo
Cough: YesNo
Breathing difficulty or unusual shortness of breath: YesNo
Abdominal pain and/or diarrhea: YesNo
Other signs: YesNo

Regarding the COVID-19:
Did you test positive in a COVID 19 test?: YesNo
Have you been in close contact* with a person who has been diagnosed with COVID 19 ?: YesNo
*Close contact is a person who, 24 hours before the onset of symptoms of a confirmed case, has shared the same place of life or has had direct contact with him, face to face, less than 1 meter of the body or more than 15 minutes.


Digital signature:
Statement of responsibility and cancellation policy:

  1. Once the service or activity has been contracted, the customer has the right to withdraw at any time before departure if the withdrawal takes place due to COVID-19 disease
  2. This cause must be duly accredited with official medical documents and/or certificates and as many as may be required
  3. Once the withdrawal has been made, the amounts paid will have been refunded to the customer within a maximum period of one month.

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