ADDISON CIRCLE YOGA
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Covid-19 & Health Declaration
Please review now and submit on Friday, Sept 25, 2020 before your arrival to the retreat.
If you have any reason to believe you have been exposed or are getting sick, PLEASE DO NOT ATTEND!
THANK YOU FOR YOUR CONSIDERATION!
*
Indicates required field
Name
*
First
Last
Email
*
Re-enter Email
*
Phone Number
*
Phone Number
*
Screening questions & declarations
Do you currently have a fever (greater than or equal to 100 degrees F)
*
Yes
No
In the past 48 hours, have you had NEW onset: (check all that apply)
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FEVER greater or equal to 100 degrees F
PERSISTENT cough
SHORTNESS of breath
NONE
In the past 48 hours, have you had ANY of the following symptoms?
*
Chills with or without repeated shaking
Muscle aches
Sore throat
Fatigue
Nausea
Diarrhea
New loss of taste or smell
NONE
In the past 14 days, have you had KNOWN CLOSE CONTACT* with a person who has confirmed COVID-19?
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Yes
No
In the past 14 days, have you had KNOWN CLOSE CONTACT* with a person experiencing symptoms of COVID-19?
*
Yes
No
* "CLOSE CONTACT" is defined as: household member, intimate partner, caregiver or having a face-to-face conversation for 10 minutes or more within distance of less than 6 feet.
We will have a touch-less thermometer to check everyone's temp daily. Research shows that for many COVID-19 cases, symptoms of
fever come first, followed by a persistent dry cough
and NOT THE OTHER WAY AROUND.
Comments or questions?
*
I agree to receiving marketing and promotional materials
Submit
HOME
BLOG
Classes
Staff
6pm Poll
Pricing
Events
VENUE
Teachers
GALLERY
Online