Return to Class

To help prevent the spread of Covid-19 in the class, every client must complete and sign this form before returning to class.

On review of the form, management may contact you to ask you to delay your return to class and will discuss a suitable future date for your return.

NB EVERY QUESTION MUST BE ANSWERED

Covid-19 Return to Class Form

Name *

First

Last

1. Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms, now or in the past 14 days? *

2. Have you been diagnosed with confirmed confirmed or suspected COVID-19 infection in the last 14 days? *

3. Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2 metres for more than 15 mins accumulative in 1 day?) *

4. Have you been advised by a doctor to self isolate at this time? *

5. Have you been advised by a doctor to cocoon at this time? *

6. Please provide details below of any other circumstances relating to COVID-19, not included in the above, which may need to be considered to allow your safe return to class *

Further information on people at higher risk from Cornovirus can be accessed on HSE.ie

7. Do you have any injuries? *

8. Do you have any illnesses? *

9. Are you taking any medication? *

10. Are you pregnant or have you had a baby in the last 12 weeks? *

11. Are there any reasons why you can't partake in exercise? If YES please speak to me before coming to class *

If you answered YES to any of the above please provide details here

Please e-sign this form by entering your name in the field below *

TERMS AND CONDITIONS *

I Accept

1. By signing this form you give permission to AK Nutrifit to use photographs that may contain you in a group of people for advertising on social media such as Facebook or Instagram. At no stage will AK Nutrifit use an individual photo of you without obtaining your permissions first 2. As there is a high demand for classes, money will be collected on the 1st week of every block of training. If you don't attend class and no payment has been received during the first week then you will lose your allocated space in the class

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Return to Class