Covid-19 Disclaimer Form

Before attending each session you MUST confirm that you agree to each of the following statements.

All fields are required.

When complete press ‘Confirm’ to submit your responses.

Please note: all fields are required


1
I confirm that I have not shown any of the following symptoms of Covid-19 in the past 14 days:

  • High temperature
  • New, continuous cough
  • Loss or change to your sense of smell or taste


2
I confirm that I have NOT been in contact with anyone who has tested positive for Covid-19 or shown any of the above symptoms in the past 14 days.


3
I confirm that I have worn a protective mask when in public situations where social distancing is not consistently possible.


4
I understand that I could be a carrier of Covid-19 and be asymptomatic.


5
I understand that I could contract Covid-19 from an asymptomatic person at the studio or from a contaminated surface at the studio.


6
I am fully aware of the studio’s safety procedures to prevent the spread of Covid-19 and agree that I will follow these procedures. (Note: the safety procedures will have been previously emailed to you and will also be posted on the studio wall)


7
I agree to inform the instructor immediately if:

  • I develop symptoms within a two week period of being in the studio
  • I learn that I have been in direct contact with someone who has later tested positive for Covid-19 within the same two week period
  • I have travelled in the last 14 days to a Covid-19 risk area


8
I agree to inform the instructor of any allergies that I may have to cleaning products, PPE or similar that may be used at this time and may adversely affect my health.


9
I agree that my data provided on this form can be used to contact me if I have been in a class with a person that has developed symptoms or has been in direct contact with somebody who has later tested positive for Covid-19.


10
I understand that if I wilfully and intentionally violate the stated hygiene policy and social distancing policy in the studio, the instructor has the right to immediately remove me from class and suspend me from attending any future classes, without a refund.


11
I agree that I will inform the instructor immediately if I learn that any of the above information changes or I obtain new information.


Click the 'Confirm' button below to submit your responses.