Self Reporting Form

This form is to prevent the spread of COVID-19 to concerhall visitors,under the KCDC (Korea Centers for Disease Control & Prevention) guidelines: How to Cope with Coronavirus Disease–19 at mixed-use facilities. Please fill out the following form completely before entering the hall. We do not use your personal information other than epidemiological investigation when patients with confirmed COVID-19 occurs.

Please input phone number.
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Please enter visitor information.

For children under the age of 14, please add it to the contact information of your legal representative.

Full Name
Program / Times (Sep 26, 2022)

1. Do you currently have fever (over 37.5°C), respirato ry disease symptoms such as cough, sore throat, bre athing difficulties, headache?

2. Have you met COVID-19 confirmed patients in the last 2 weeks?

3. Have you traveled overseas within the last 2 weeks?

※By submitting this form, you confirm to have cons- ented to provide personal information and measuri- ng body temperature to prevent infectious diseases and epidemiological investigation. (If there are no c- onfirmed patients, the submitted form will be discar- ded within 30 days.)

Privacy Policy

  • ■ 개인정보 수집 · 이용에 대한 동의
    본인은 『개인정보보호법』에 따라 신종 코로나바이러스 예방 및 관리 목적으로 아래의 내용과 같이 롯데콘서트홀이 본인의 개인정보를 수집 · 이용하는 것에 대하여 동의합니다.
  • ■ 개인정보의 필수적인 수집 · 이용에 관한 사항
     가. 수집 항목 : 성명, 연락처, 관람일시
     나. 수집 · 이용 목적 : 의료 및 공중보건
     다. 보유기간 : 수집일로부터 30일 이내에 일괄 파기
  • ■ 개인정보 3자 제공 및 이용 목적 (발생 시)
     가. 제공받는 자
       1. 질병관리본부
       2. 관람 공연 기획·주최사
     나. 이용 목적: 의료, 공중보건, 결제대금에 대한 사후 처리

Self Reporting Form
It creating completed.

The message was sent to the mobile phone number you entered.
Please present the received message at the entrance of the audience and enter.

Depending on the contents of this form, watching a performance and use of facilities may be restricted. Please comply with the instructions of staff.

Self Reporting Form

Today, there are no performances that require a questionnaire.

Please use it on the day of the performance.