Mindful Pilates Health Declaration Form
The health and safety of all visitors and staff at Mindful Pilates is of top priority to us. Therefore, we have put in place a list of precautionary measures in light of the COVID-19 situation.

Subject to these measures, visitors must fill in this Quick Health Declaration Form before entering our studio.*

*If any of the statements cannot correctly describe your current status or if we have not received your reply on this health declaration, you will not be permitted to access the studio facility.

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Email *
Your full name *
Your mobile number *
Please read and tell us if the following statements can correctly describe your current status up to the class start time.
1. You have been vaccinated and fulfilled the requirement of HK Govt. Vaccine Pass to enter the studio.
2. You have not traveled outside of Hong Kong in the past 14days
3. You are not living with someone who has travelled outside of Hong Kong in the past 14 days.
4. In the past 14 days, you have not been tested as COVID-19 positive
5. In the past 14 days, you have not been in close contact / or living with someone who is tested COVID 19 positive.
6. Up to the class start time, you do not have any covid19 symptoms such as runny nose, coughing, sore throat, headache, fever, shortness of breath, or breathing difficulty.
7. If you are required by the government to take a compulsory covid19 screening test, you have already done so and received a negative testing result.
Can ALL the above statements correctly describe your current status?
Clear selection
Declaration and disclaimer
If any of the above statements cannot correctly describe your current status or we have not received your reply on this health declaration, you will not be permitted to access the studio facility.

The information submitted above will only be used to ensure the safety and health of the participants, and will not be distributed to third parties except for medical institutions in emergency.
By selecting "I agree" , you hereby declare that the above information provided is, to the best of your knowledge, complete and true. You agree that your personal data may be used by Mindful Pilates Limited for administration, organization and emergencies. *
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