declaration form PLEASE FILL OUT THE FORM and make the payment 2-3 days before the lesson

Form must be returned and payment made no later than 48 hours before your lesson time.
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 Covid Safe Venue
  • I confirm I am not vulnerable or at risk:
  • I confirm no one in my household is vulnerable or at risk:
  • I have read, understood and will follow all the venues instructions and their H&S:
  • I agree to wear a face mask (or requested a screen already if exempt):
  • I have familiarised myself with the social distancing rules and will follow these at all times:
  • I confirm I have not had any symptoms outlined in the policies within the last 10 days and not been contacted by Test and Trace:
  • I have consulted everyone in my household and confirm no one had any symptoms outlined in the policies within the last 10 days:
  • I confirm I have not been in close contact to anyone that had any symptoms outlined in the policies within the last 10 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 procedures, items to take 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 asterisked boxes, otherwise you will receive an error message: