Contract Tracing Form

CONTACT TRACING FORM

Kindly complete this form BEFORE ENTERING the restaurant.
When done, press SUBMIT, enter and enjoy dining at Cucina di Francesco!

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

I hereby authorize Cucina di Cinque Corporation to collect and process the data indicated herein for the purpose of contact tracing effecting control of the COVID-19 transmission. I understand that my personal information is protected by RA 10173 or the Data Privacy Act of 2012 and that this form will be destroyed after 30 days from the date of accomplishment, following the National Archives of the Philippines protocol.

Submit