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MANDALA YOGA IN PERSON CLASS STUDENT DECLARATION
IF YOU REPLY NO TO ANY OF THE FOLLOWING QUESTIONS YOU ARE KINDLY REQUESTED NOT TO ATTEND AN IN-PERSON CLASS
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Email
*
Your email
PLEASE NOTE: Your name, contact details and answers to this declaration will be used by MANDALA YOGA for the sole purpose of ensuring health and safety of our teachers, students and facilitating contact tracing.
Your name and surname
*
Your answer
Please enter your phone number
*
Your answer
I confirm that I have not travelled outside of the Republic of Ireland in the last 14 days.
*
Yes
No
Required
I confirm that I have not been advised by a doctor to self isolate or cocoon in the last 14 days
*
Yes
No
Required
I confirm that I do not have now NOR have I had in the last 14 days symptoms such as fever, cough, sore throat, high temperature, runny nose or any flu-like symptoms,
*
Yes
No
Required
I agree to abide by all social distancing and class rules as designated by staff and management of Mandala Yoga
*
Yes
No
In the event of me developing symptoms such as fever, cough, breathlessness, sore throat, runny nose etc. I agree to immediately contact Mandala Yoga to inform them of this
Yes
No
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