Bunda Mulia School

Visitor Form

Thank you for visiting Bunda Mulia School (SPK). In order to support government's program and to stop the spread of Covid-19 in the school premise, we request you to fill up this form below.

Email Address *

Date of Visit (eg. 12/31/2021) *

Name as in Citizen ID Card *

Gender *

Male

Female

Mobile Number *

Date of Birth (eg. 12/31/1990) *

Have you been in direct contact with anyone who is tested positive in the past 14 days? (Type YES or NO) *

I declare that I am healthy and not having any symptoms such as fever, cold, cough, and sorethroat at the moment. I am visiting the school on my own will and without anyone forcing me to come. (Type YES or NO)

Meeting with: *

Time of Appointment (eg. 8, 9 or 10) *

Have you been tested positive for Covid-19? (Type YES or NO) *

Number of Guest(s) for this visit *

History of Vaccination *

A copy of your response will be emailed to the address you provided

	Yes	No	Not Sure
Fever
Dry Cough
Tiredness
Loss of Taste or Smell

Plan a Visit

Visitor Form