Month .................... Year ............

Please fill in the day (monday, tuesday, wednesday, thursday, friday, saturday, sunday) of you visit on the line of the correct date. The numbers in front of time line represent the days of each month.
Then indicate the time of your visit on the timescale with a forwardslash for approximate time of arrival and a forwardslash for aproximate time of departure.
Then fill in the correct time of you visit in hour and minutes Please take a 5 minute reserve in the time you write down. Visits can be checked, so don't indicate periods of time which you weren't present.

1. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

2. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

3. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

4. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

5. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

6. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

7. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

8. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

9. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

10. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

11. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

12. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

13. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

14. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

15. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

16. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

17. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

18. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

19. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

20. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

21. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

22. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

23. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

24. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

25. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

26. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

27. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

28. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

29. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

30. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

31. ...................... - time of your visit: 8 - 9 - 10 - 11 - 12 - 13 - 14 -15 - 16 -17 - 18 - 19 -20
Time of your arrival: .................. Time of your departure: .....................

Time of your arrival: .................. Time of your departure: .....................

................................................................................................................................................(name, address), declare that all days and times of my visits as indicated above are correct.

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(Your signature placed above)