declaration form PLEASE FILL OUT THE FORM 1-2 DAYs BEFORE YOUR LESSON

NO SOONER THAN 48HRS BEFORE
NO LATER THAN 24HRS BEFORE

All fields must be filled out and all boxes ticked. Failing to do so will end up in an error message and you will have to go back and do it all again

Covid19 Declaration Form Lesson at Teacher's House
  • I confirm I am not vulnerable/at risk:
  • I confirm no one in my household is vulnerable/at risk:
  • I have read, understood and will follow all the venues instructions and their HS:
  • I agree to wear a face mask and/or visor and know how to use these (or requested a screen if you cannot wear one):
  • I have read and will follow the social distancing rules at all times (min 2m for singing, min 1m for piano lessons):
  • I declare and confirm I have not had any symptoms outlined in the policies within the last 14 days :
  • I have consulted everyone in my household and confirm no one had any symptoms outlined in the policies within the last 14 days:
  • I declare and confirm I have not been in close contact to anyone that had any symptoms outlined in the policies within the last 14 days :
  • I will contact Eximo immediately if I / someone in my household or anyone I'm in close contact with after sending this form develops symptoms :
  • I have made a note of the checklist items and am prepared for the lesson:
  • I have read and agree to the general T&C's:
  • Whilst risk has been assessed and mitigated as much as possible, there is still a risk of infection. I confirm I am happy to take this risk:
  • Check you have filled out all the * boxes, otherwise you will receive an error message::