Questionnaire for investigation of reports of guest illness

Page 1: Your personal information

Your personal information

1.1. Your first name Required

Please enter a response that only contains letters.

2.2. Your last name Required

Please enter a response that only contains letters.

3.3. Your date of birth Required

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

(dd/mm/yyyy)

4.4. Your gender Optional

Male

Female

Prefer not to say

Other

a.4.a. If you selected Other, please specify:

5.5. Your email Required

Please enter a valid email address.

6.6. Your home telephone number

7.7. Your mobile telephone number Required

8.8. Your home address Required

a.8.a. Postcode Required

9.9. Your temporary/current address Required

a.9.a. A local contact telephone number where you can be reached

10.10. Name of your parent/guardian if applicable

a.10.a. Contact information of parent/guardian if applicable