Bentleigh East, VIC Australia

(SE Melbourne)

COVID-19 Screening Form

The form below is to be completed prior to EVERY in-person lesson.
Please answer these questions truthfully. It is so important for us all to play our part in keeping each other safe and well.

"*" indicates required fields

Name*
Do you have ANY of the following symptoms: fever, chills, cough, sore throat, shortness of breath, runny nose, loss of smell or taste?*
Have you been in direct contact with someone who has suspected or diagnosed Coronavirus in the past 14 days?*
Have you returned from international or national travel in the past 14 days?*

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