MANDATORY HEALTH & TRAVEL DECLARATION

To protect and safeguard the Breathing Place Community, all guests must complete the following declaration form prior to every visit to Breathing Place without exception. Your data and answers to this declaration will be used by Breathing Place for the sole purpose of ensuring health and safety of our guests, staff and to facilitate contact tracing.

Have you had any of the following symptoms of COVID-19 in the past 14 days?

If you have answered YES to any of these questions you should stay at home and contact your GP by phone for further advice. At all times - if you feel unwell stay at home.

If you have travelled outside of Ireland for any reason, or have been in contact with anyone who has, please do not come to class for 14 days.

Please (digitally) sign this form to confirm that the details above are true to the best of your knowledge and that: