DURATION & LOCATION

Check-in Date

Check-out Date

Name of Cottage
Buffelsbank CottageWouterspan LodgeMosesberg CottageLonglands CottageDelportshoop CottageFineview Cottage

GUEST REGISTRATION CARD

Full Name of Guest

South African ID Number / Passport Number + Country

Physical Address

Email Address

Telephone Number

Vehicle Registration Number

PAYMENT INFORMATION

Are you the person paying?Yes, I'm payingNo, another guest is paying

If Yes, please state Total Cost of Accommodation

Payment Type
VisaMastercardAMEX/DinersEFTGift VoucherOther

Please include in our tab (Day 1)—Please choose an option—Add breakfast basket for 1Add breakfast basket for 2Add braai basket for 1Add braai basket for 2Add picnic basket for 1Add picnic basket for 2Add massage for 1Add massage for 2

Please include in our tab (Day 2)—Please choose an option—Add breakfast basket for 1Add breakfast basket for 2Add braai basket for 1Add braai basket for 2Add picnic basket for 1Add picnic basket for 2Add massage for 1Add massage for 2

Please include in our tab (Day 3)—Please choose an option—Add breakfast basket for 1Add breakfast basket for 2Add braai basket for 1Add braai basket for 2Add picnic basket for 1Add picnic basket for 2Add massage for 1Add massage for 2

Please include in our tab (Day 4)—Please choose an option—Add breakfast basket for 1Add breakfast basket for 2Add braai basket for 1Add braai basket for 2Add picnic basket for 1Add picnic basket for 2Add massage for 1Add massage for 2

Please include in our tab (Day 5)—Please choose an option—Add breakfast basket for 1Add breakfast basket for 2Add braai basket for 1Add braai basket for 2Add picnic basket for 1Add picnic basket for 2Add massage for 1Add massage for 2

Please include in our tab (Day 6)—Please choose an option—Add breakfast basket for 1Add breakfast basket for 2Add braai basket for 1Add braai basket for 2Add picnic basket for 1Add picnic basket for 2Add massage for 1Add massage for 2

Please include in our tab (Day 7)—Please choose an option—Add breakfast basket for 1Add breakfast basket for 2Add braai basket for 1Add braai basket for 2Add picnic basket for 1Add picnic basket for 2Add massage for 1Add massage for 2

How did you hear about us?
Google SearchWord of MouthTravel Agent/Tour OperatorTripadvisorSocial MediaBooking.comOther

Your accommodation is situated on a working farm; needless to say this means that we ask that certain considerations hereunder be considered.
We further request that all in your party consider the water shortage our region is experiencing.

Occupancy Terms and Conditions:
1. Visitors are welcome but only in-house guests may sleep on the property at night.
2. Extras to be settled at Reception prior to departure
3. Cottage keys to be dropped off at Reception on departure
4. Check-out time strictly by 10:00
5. Pets allowed on prior arrangement
6. Dust damages our vines and olives. Please drive slowly. Max speed limit 20kph

COVID-19 DECLARATION

Please note that all fields are compulsory and we cannot check you in without this information. Please state "none" where applicable.

Age of Guest

General health, chronic and other conditions

Physical Impairments

Please indicate if you have had any of these symptoms in the last 30 days
HeadachesTemperature above 38 degreesDry coughRed eyesScratchy throatVomitingDiarrhoeaSevere fatigueShortness of breathNone of the above

Are you a smoker?YesNo

How would you rate your fitness level?—Please choose an option—Below averageAverageAbove average

Covid-19 status declaration—Please choose an option—Tested / Positive / RecoveredTested / Positive / Require Isolation or QuarantineTested / NegativeNot Tested / Unknown

Details of your full current trip for tracing purposes

Recent travel history other than this trip (1 month prior)

Next of kin (full name) - Not travelling with you

Next of kin contact number

Do you have travel insurance?YesNo

I confirm that all the information I have provided is both true and accurate.
Yes

By clicking here, you confirm your declaration to be true and accurate, according to the information you have provided and submitted. Should any of the information be incorrect or false, you personally accept full responsibility and liability of your actions. Orange Grove Farm indemnifies itself and its directors and employees from these actions.

Signature (draw your signature below, using the mouse/trackpad)