Declaration Form - Holiday Van Owners

Entry to caravan park or camping ground under NSW Public Health Order

To protect the health and well-being of everyone in Blacksmiths Beachside Holiday Park and prevent the spread of COVID-19 in the park and our community, you must complete this Declaration Form to confirm your recent travel, health status and contact details (as well as recent travel, health status and contact details of any persons accompanying you). We may provide this information to NSW health authorities if necessary for contact tracing purposes.

The information below must be filled in prior to every visit from 1/6/2020. Gate codes will be reset according to arrival and departure dates.

If you are experiencing symptoms of COVID-19 including sore throat, fever, dry cough, shortness of breath (full list of symptoms available here), please DO NOT come to the park and seek medical advice through your doctor or by calling the National Coronavirus Hotline on 1800 020 080.

If you have any queries please email the park at [email protected]. You can also find additional information about COVID-19 measures we are taking at the park here.

Full Name

Mobile Phone

Email address

Holiday van site number

Arrival date

Departure date

I confirm:

Q1 - I/we have received both doses of Covi-a9 vaccination or I/we reside within the Lake Macquarie LGA (proof of address must be provided to the park)

Q2 - I am/we are not required to be in self isolation/self quarantine

Q3 - To the best of my knowledge, I/we have not been in close contact with a person who is a suspected or confirmed case of (COVID-19) in the past 14 days

Q4 - I/we have not had a fever, cough, sore throat, shortness of breath or other cold/flu-like symptoms in the last 72 hours and I am/we are otherwise well

Please provide details of all persons staying overnight at your holiday van site:

Guest 1 Name and Contact Number

Guest 2 Name and Contact Number

Guest 3 Name and Contact Number

Guest 4 Name and Contact Number

Guest 5 Name and Contact Number

Guest 6 Name and Contact Number

Guest Name 7 and Contact Number

Guest Name 8 and Contact Number

Please provide details of all day visitors to your site:

Day Visitor 1 Name and Contact Number

Day Visitor 2 Name and Contact Number

Day Visitor 3 Name and Contact Number

Day Visitor 4 Name and Contact Number

Day Visitor Name 5 and Contact Number

Day Visitor Name 6 and Contact Number

Declaration

By ticking this box you agree with the terms and conditions below:
I agree to comply with all social distancing measures, good hygiene practices and park rules. I declare that the answers provided above are true and accurate for myself and all the listed parties.

OUR HOLIDAY PARKS

Belmont Lakeside Holiday Park

Blacksmiths Beachside Holiday Park

Swansea Lakeside Holiday Park

Wangi Point Holiday Park

Sails Holiday Park

Declaration Form - Holiday Van Owners

Entry to caravan park or camping ground under NSW Public Health Order