COVID-19 Consent Form

To be completed on the first visit to the studio, from 27th July 2020

Name
First Last
I confirm that I have not had any of the following symptoms in the last 14 days: fever, shortness of breath, loss of sense of taste or smell, dry cough, runny nose or sore throat.*
- Yes
- No
I confirm that to the best of my knowledge, I have not been in close contact with anyone with confirmed COVID-19 in the last 14 days.*
- Yes
- No
I confirm I am aware of the studio's requirement for social distancing in the studio.*
- Yes
- No
I confirm that I have not returned from outside the UK in the last two weeks.*
- Yes
- No
Consent
By entering your name and submitting the form you are declaring that you have been screened for COVID-19, and are happy to be verbally screened on every visit to the studio.
Date
Date Format: MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.