declaration form PLEASE FILL OUT THE FORM 2-3 DAYs BEFORE YOUR LESSON

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 Student's House
  • I confirm I am not vulnerable/at risk:
  • I confirm no one in my household is vulnerable/at risk:
  • I confirm I have a big enough dedicated teaching room no one will interfere with during the lesson time as outlined in the procedures:
  • I know what I need to do according to policies to get my house and dedicated teaching space ready :
  • I agree to wear a face mask and know how to use one (or requested a screen if exempt):
  • I have familiarised myself with the social distancing rules and will follow these at all times:
  • I will keep the teaching room ventilated throughout the lesson and for some time before/after the lesson:
  • 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 am prepared for my lesson and have all my lesson materials ready:
  • 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::