Select the start date of the retreat you will be attending
Aug 28thSept 4thSept 11thSept 18thSept 25thOct 2ndOct 9thOct 16th

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

• 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

• agree to wear a mask or visor if requested to do so by any of our staff
  YesNo

• remain respectful of individual preferences in relation of Covid 19 whether this be wearing of a mask, 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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