Vaccine Guest Form
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First name *
Surname *
Mobile number *
E-mail address *
Emergency Contact Name
Emergency Contact Number
Discovery Member
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Receive Free training vouchers
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Do you, or anyone you've been in close contact with, have any of the following symptoms associated with COVID-19: Cough, sore throat, shortness of breath, loss of taste/smell or a fever (>37.5°)? *
Have you, or anyone you are with, been in close contact (within the past 14 days) with a known or probable case of COVID-19 infection, without the appropriate PPE? *
Disclaimer: I understand and agree to the following disclaimer: To the fullest extent permitted by law, Virgin Active South Africa (Pty) Ltd or Virgin Active Botswana (Pty) Ltd, as the case may be, or any of their direct or indirect international affinities who may give our access to their facilities as a result of this Contract and / or their directors, employees and independent contractors (collectively- Virgin Active) shall not be liable for any loss or damage whatsoever and howsoever arising (including from any nutritional, exercise or any advice) suffered by me or any of my dependents including (without limitation) loss or damage to person or property from a negligent (other than a grossly negligent) act or omission of Virgin Active, other members or guest. I agree to this disclaimer and to comply with the Rule book that governs the basis upon which may enter and use these facilities.: https://hello.virginactive.co.za/assist/va-rule-book *
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