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Physio Led Pilates

Covid-19 Health Screening Form

How are you feeling today?

24 HOURS prior to attending class you must confirm the following statements by checking the boxes below. If you are unsure about any of the questions, please contact your instructor to discuss further. If we do not receive this form prior to you attending class then you will not be able to attend.

Disclaimer and consent

Please read this COVID-19 screening and consent disclaimer thoroughly and sign below.

 

I have had the opportunity to ask all the questions I wish to, and all my questions have been answered to my satisfaction. By signing below, I agree that I consent to attend a venue based class during the COVID-19 pandemic. If I do not consent to this, then it will be documented by my Physio Led Pilates instructor. By submitting this COVID-19 Screening Form, I thereby agree to all sections in this disclaimer.

Please inform us of any changes

Thanks for submitting!

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