Covid-19 Questions

Please enter your full name
Living environment(Required)
Are you, or is your family/partner, currently experiencing any of the following symptoms:
Covid-19(Required)
Have you had and/or recovered from the Covid-19/Corona disease in the last 14 days?
If your answer below is 'Yes' or 'Maybe', please send us an email with details so we can assess your situation.
Risk(Required)
Are you part of a risk group?
Please inform us in case there are any important details we should know about. Such as medication, past injuries, travel plans, etc.
We recommend you to arrive at 11:00AM. If your travel plan (train/plane) requires you to arrive after 1:00PM, you can inform us here.
Please fill in the name and phone number of the person we should contact in case of an emergency. (including country code if outside The Netherlands)
Declaration:(Required)
Please mark all 4 of the following statements, or contact us immediately in case you disagree with any of them.