Atlantic Aikido COVID-19 Declaration Form
1. Your name: *
2. Please give a contact phone number (for contact tracing): *
3. Have you been diagnosed with confirmed or suspected COVID-19 infection? *
4. Have you had any fever, high temperature, cough, shortness of breath, changes to taste or smell, or other symptoms of COVID-19 over the past 14 days? *
5. Have you been in close contact within the past 14 days with someone showing symptoms of the virus? *
6. Have you been in a country within the past 14 days that is not on the government green list? *
7. Have you been advised by a doctor to cocoon or self-isolate? *
8. Have you read the Atlantic Aikido COVID-19 Policy (available at http://www.atlanticaikido.com/covid)? *
9. Do you agree to follow all of the guidelines of this policy? *
10. If you wish to provide any more information, you may do so here.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy