Select the start date of the retreat you will be attending
Dec 4thDec 27thJan 3rdJan 15thJan 22ndJan 29thFeb 5thFeb 12th

In the past 21 days, have you

• been in close contact with anybody who is infected or at high risk of being infected with Covid 19
  YesNo

• had any possible symptoms including cough, high temperature (above 38 degrees Celsius), loss of taste or smell, or any flu like symptoms
  YesNo

• travelled in a plane
  YesNo

Please confirm that you will

• agree to your temperature being tested before you enter the retreat centre
  YesNo

• wash your hands well with soap and water for minimum 20 seconds when you arrive at the centre and also frequently each day
  YesNo

• wear a facemask while indoors unless eating, or on your yoga mat in the yoga room or in your own bedroom.
  YesNo

• agree to follow safe coughing/sneezing etiquette
  • Turn your head away from others and physically distance as much as possible
  • Use a tissue to cover your nose and mouth
    • No tissues? Cough/sneeze into elbow
  • Do not touch surfaces with your hand after this and use tissue or clothing to open door handle or ask staff to assist
  • Clean your hands after discarding tissue using soap and water for 20 seconds or alcohol gel for at least 15 seconds
  • If a fit of coughing or sneezing that you go outdoors immediately

  YesNo

• agree to be mindful of social distancing and keeping a safe distance from other guests and staff
  YesNo

• adhere to any social distancing guidelines given by any of our staff
  YesNo

• remain respectful of individual preferences in relation of Covid 19 whether this be social distancing or other precautions which make people feel safe
  YesNo

Please type your full name below to act as a signature of your agreement that all the details you have completed are correct.

Your Name (first name, surname)

Your Email (required)

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