Pre-Assessment

COVID 19 DECLARATION FORM

Due to the COVID-19 pandemic, we are taking extra precautions with the intake of each client. Please answer these questions truthfully so we may continue to do our best to stop the spread & keep both you and our trainers safe.

Name

First Name

Last Name

Date

month - date -year

YYYY

Symptoms include: Fever Fatigue Dry cough Difficulty breathing Sore throat Loss of smell or taste I understand the above symptoms and CONFIRM that I, as well as all members of my household, DO NOT currently have nor have experienced COVID-19 symptoms within the last 14 days.

I affirm that I, as well as all members of my household, have not been diagnosed with COVID-19 within the last 14 days.

I have not travelled outside of UK in the last month

I understand that this business and personal trainer cannot be held liable should I experience exposure to the virus or any other contagion as a result of my providing misinformation on this form.

I acknowledge that I must comply with all set procedures to reduce the spread while attending my session.

By signing this form, I acknowledge that I am aware of the risks involved and give consent to attend WDP GYM.