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Kioto BJJ Check In
Members MUST check in before attending class
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Date & time of class being attended
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Name
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Have you tested positive for COVID-19 within the last 14 days?
*
Yes
No
Have you been in close contact / exposed to anyone with COVID-19 within the last 14 days?
*
Yes
No
Do you currently, or have you displayed any symptoms of COVID-19 within the last 14 days?
*
Yes
No
Have you traveled to a state with significant community spread of COVID-19 for longer than 24 hours within the past 14 days?
*
Yes
No
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