Yoga with Lora Covid-19 Waiver

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Email *

Full name *

Phone number *

Today's date *

*PLEASE NOTE* This Covid-19 wavier only needs to be filled in once per student.

Are you, or anyone that you know and have been in contact with currently awaiting COVID-19 test results? *

Yes

In the last 14 days have you, or anyone in your household tested positive for COVID-19 or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE? *

Yes

If you answered "Yes" to either of the above questions, please elaborate.

Have you or anyone in your household experienced any of the following as new or worsening symptoms within the last 14 days? *

Fever or chills

Sore throat; trouble swallowing

Runny nose, stuffy nose or nasal congestion (not allergy related)

Shortness of breath or difficulty breathing

Decrease or loss of smell or taste

Nausea, vomiting, diarrhea, abdominal pain

Not feeling well, extreme tiredness, sore muscles

None of the above

Required

I agree to maintain a minimum of 2 metres / 6 feet from the other students while waiting outside the studio, as well as in the studio whenever possible. *

I agree

I disagree

I will wear a mask at any time that I am not in my individual practice space. This includes but is not limited to: waiting outside of the studio prior to entering (when social distancing can not be maintained), entering and exiting the studio, and using the washroom. *

I agree

I disagree

I will sanitize or wash my hands upon arriving inside the studio prior to each class. *

I agree

I disagree

I will contact Yoga with Lora if myself or a family member become COVID-19 positive at any time after I have attended classes. *

I agree

I disagree

I will not enter into discussions about Covid-19 vaccinations while inside the Yoga with Lora studio or while on Yoga with Lora property unless within the privacy of my own vehicle. *

I agree

I disagree

I acknowledge and understand that Yoga with Lora has the right to refuse entry to anyone for any reason in order to maintain the safety of the Yoga with Lora community and that this decision lies solely at the discretion of Lora Colautti and the Yoga with Lora teachers. *

Yes

By completing this form I agree to all information being true and same each time I attend a class, workshop or events of any kind within the Yoga with Lora studio. *

I agree

I disagree

A copy of your responses will be emailed to the address you provided.

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