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Drakes Gym COVID-19 Disclaimer
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Email
*
Your email
First Name
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Your answer
Last Name
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Your answer
Phone Number
*
Your answer
Address
*
Your answer
Are you experiencing a cough?
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Yes
No
Are you experiencing a shortness of breath?
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Yes
No
Have you had a fever in the past 14 days?
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Yes
No
Have you had any contact with anyone that has suspected COVID-19 in the past 14 days ?
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Yes
No
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I have understood, read and completed this form truthfully to my knowledge.
Required
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I knowingly and willingly consent to having services at Drakes Gym during the COVID-19 pandemic.
Required
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I consent for the services to be carried out which involves a staff member of the Drakes Gym team being in physical contact with me with less than 2 metres distance
Required
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I confirm to my knowledge that I, my household or social bubble have not been in contact with anyone that has had symptoms of COVID-19 in the last 14 days.
Required
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To prevent the spread of the virus and protect each other, I confirm to follow the national guidelines.
Required
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If guidelines are not strictly followed, I understand that Drakes Gym has the right to cancel the PT session with the full cost of the session being charged.
Required
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I confirm that I release the Drakes Gym team member performing the service and Drakes Gym as a business from any and all liability for the unintentional exposure or harm due to COVID-19.
Required
Signature
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Your answer
Date
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