COVID Questionnaire

This is supplementary to the standard Pawprints, Pilates and a piece of Cake Enrolment Form, which must already have been completed.

This form needs to be completed and submitted before your first visit to an in person class.

If you have any of the following symptoms or are feeling unwell, please do not come to class and follow the latest NHS guidance:

Fever; a new and continuous cough; loss of taste or smell

 Also please do not come to class if

  • you have had a Test & Trace ‘ping’.
  • a member of your household or close contact circle has any of the above symptoms.
  • you have knowingly been in close contact with anyone who has tested positive for Covid-19 in the last 14 days.

Please also refrain from coming to class if you have any of the following symptoms and these are new and unexplained:

  • shortness of breath;
  • fatigue;
  • loss of appetite;
  • muscles aches and pains;
  • sore throat;
  • headache;
  • nasal congestion;
  • diarrhoea;
  • nausea and vomiting.

Further advice is available from the NHS Coronavirus Service: https://www.nhs.uk/conditions/coronavirus-covid-19 or call 111.

Your Name *
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Class Attending
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Have any of your personal details changed since you filled in an Enrolment Form?
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If you answered YES to the previous question please fill in your new details below:

Email Address
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Address
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COVID Questions

Have you had, or suspect you have had Covid-19 Coronavirus?
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If yes, when?
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If yes, was this diagnosed by means of a positive test result?
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Have you been admitted to hospital due to Covid-19 symptoms?
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How long were you in hospital for?
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If you have had Covid-19, do you know of any reason you should NOT exercise, or have you been advised not to partake in exercise by a medical practitioner?
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Are you still experiencing symptoms post Covid-19? If yes, please list them:
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Are you considered to be at extra risk (i.e. clinically vulnerable)?
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Do you have a family member who is vulnerable or extremely vulnerable?
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Information about Cleaning Products

Are you allergic to specific cleaning products?
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If yes, please give details:
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If there anything else you would like us to know please use this space.
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