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Wah Lum Consultation Health Screening
Please answer the questions in order to assist us with continuing to provide a safe training environment. We respect your privacy. By filling out this form you agree to wear a mask to your consultation and observe distancing from others.
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Email *
Which classes are you interested in? *
Has anyone planning to visit the Temple for the consultation recently been infected with covid19 or been in contact with anyone who has tested positive for covid19 within the past 2 weeks? *
Does anyone planning to visit the Temple have any symptoms of a virus or illness? (such as but not limited to: fever, coughing, shortness of breath, fatigue, muscle soreness, sore throat, runny nose, nausea, etc.) *
Have you received the covid19 vaccine? *
For KIDS/LM class: Has your child received the covid19 vaccine? *
The following section is in regards to your comfort levels while training.
I would feel comfortable training OUTDOORS WITHOUT distance restrictions and WITHOUT a mask. (no physical contact with others) *
I would feel comfortable engaging in partner work: self defense/contact drills/bagwork with other students or instructors: (physical contact involved) *
I would agree to show proof of my vaccination to the Wah Lum administration to participate in classes involving physical contact and limited distancing. *
By typing my full name below, I agree this acts as my official signature. *
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