COVID-19 Screening & Waiver
Please respond to the following questions before attending a yoga class, event,
or receiving a wellness session:

1)  Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
2)  In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?
3)  Have you tested positive for COVID-19 in the last 10 days? 
4)  Did you travel outside of Canada in the past 14 days?
5)  Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
6)  Do you have any of the following symptoms?
• Fever
• New onset of cough
• Worsening chronic cough
• Shortness of breath
• Difficulty breathing
• Sore throat
• Difficulty swallowing
• Decrease of loss of sense of taste or smell
• Chills
• Headaches
• Unexplained fatigue/malaise/muscle aches (myalgias)
• Nausea/vomiting, diarrhea, abdominal pain
• Pink eye (conjunctivitis)
• Runny nose or nasal congestion without other known cause
7)  If you are 70 years of age or older, are you experiencing any of the following symptoms?
• Delirium
• Unexplained or increased number of falls
• Acute functional decline
• Worsening of chronic conditions
 
If you answered YES to any of these questions, please postpone your visit to the studio until the issue is resolved.
If you answered NO to ALL of these questions, please continue:

    I understand that the healing session will be cancelled immediately if I do not meet the pre-screening criteria upon physical presentation at the studio location, and I will be refused access to the in-person yoga class or event.    
    I understand that while the healing practitioners and yoga teachers at Heart Journey Yoga & Wellness are following health and safety guidelines recommended by the government, there are no guarantees that I will not come in contact with COVID-19.
    By signing this form in person or electronically, I confirm that my responses reflect my state of health at this time to the best of my knowledge. I acknowledge that I am aware of the risks involved and I am willing to receive a wellness session or to attend a class/event.