COVID-19 Assessment
It is mandatory that everyone who enters the Vancouver Mind-Body Centre studio complete this screening PRIOR to entering the space. This checklist may be updated as the situation progresses over the next weeks and months.
Please fill out this form on the DAY of each class, at least 1 hour before EACH class. The submission time will be noted and your instructor will confirm your submission before training.
* Required
Email
*
Your answer
Full name
*
Your answer
Date of class
*
MM
/
DD
/
YYYY
Time of class
*
Time
:
AM
PM
Name of class
Aikido
Conditioning & Recovery
Core Strength
Fitness Kickboxing
Karate
Kettlebells
Strength & Agility
Clear selection
Are you Experiencing any of these symptoms?
*
Fever greater than 38C or chills
Stuffy and or runny nose
Sore throat or difficulty swallowing
Sneezing
Coughing
Headache
Loss of appetite
Shortness of breath
Loss of sense of smell
Fatigue related to illness
Muscle aches related to illness
Required
Have you or someone in your household travelled outside of Canada in the last 14 days?
*
Yes
No
Have you, or has anyone in your household been in contact in the last 14 days with someone who is being investigated or who has a confirmed case of COVID-19?
*
Yes
No
Are you currently being investigated as a suspect case of COVID-19?
*
Yes
No
Have you tested positive for COVID-19 within the last 10 days?
*
Yes
No
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