The Retreat COVID Form — My Kind Of Mind

The Retreat Covid Consent Form

Ahead of The Retreat this weekend, we ask all participants to complete the following COVID screening form. While every consideration has been given to reduce contact and the risk of spreading coronavirus, attending The Retreat is at your own risk.

While COVID restrictions have been relaxed, including the non-mandatory use of face masks and the 2 metre rule, we kindly ask all participants to be kind and considerate of others attending the event.

If you start to display symptoms ahead of the event, please contact the event orgnaiser Holly Smith as soon as possible at holly@mykindofmind.co.uk

Name

First Name

Last Name

Email

Do you or any member of your household currently have any of the symptoms of COVID-19?

High temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)

New, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)

Loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to usual

Are you or any member of your household currently required to self isolate?

Have you or any of your household been contacted by the Test and Trace Team and advised to self-isolate?

Have you returned from foreign travel within 14 day from a country that requires you to self isolate?

The information I have given in this form is honest, accurate and correct to the best of my knowledge. I appreciate that although all reasonable steps to reduce risk of infections have been taken, including screening potential Covid-19 cases, and undertaking increased hygiene protocols, including the provision of hand sanitizer, there may still be a risk of infection from face-to-face interactions. I knowingly and willing consent to my participation at The Retreat.

I consent

I do not consent