appointment-confirmation

Appointment Confirmation Form

This is a pre-arrival digital sign-in which will save time during your appointment. The details here recorded will be used for contact tracing if required. They will not be used for any other reason, nor passed to any third party for commercial or email advertising (spam).

I/we wish to visit your address by appointment as arranged for

Appointment date

Enter the date of your appointment dd/mm/yy

Meeting time assigned

Enter the time of your appointment hh:mm

Meeting type

A recurring individual lesson A recurring group class A first meeting, consultation or audition A once-off business meeting

Select one option that describes your meeting

How many will attend with you?

Just me 1 other 2 others 3 others

Meetings limited to four for social distancing during the pandemic.

My name is

Phone Number

Please use international format

Name2

Name3

Name4

Please answer with care...

If you can't make all of the following assertions, please stay at home. Phone 01-842 2463 to give notice of absence. If you have to miss an individual lesson due to COVID-19, perhaps you can avail of a Video Performance Report instead. (See details in our Covid-19 Protocol document).

If you can't make all of the following assertions, please stay at home. Phone 01-842 2463 to give notice of absence.
We hope you will be able to make the next class!

If you can't make all of the following assertions, please stay at home. We will accomodate you with a new appointment when you are ready.
It is wiser to cancel the meeting rather than risk passing the COVID-19 virus to others who may visit after you.
Please phone 01-842 2463 if you must re-arrange.

Assertions: Click on each one that is true

I have not tested positive for COVID-19 during previous 14 days No one in my household has tested positive for COVID-19 during previous 14 days My temperature is normal and below 38 degrees Celcius I do not have any symptoms of COVID-19 (aches & pains, breathlessness, cough, fatigue, fever, high temperature, runny nose, sore throat) I have no reason to isolate I will use the hand sanitiser in porch before entry. Wearing a facemask is now optional.

Assertions

I have not tested positive for COVID-19 during previous 14 days No one in my household has tested positive for COVID-19 during previous 14 days Each of the above has normal temperature below 38 degrees Celcius Each of the above do not have any symptoms of COVID-19 (aches & pains, breathlessness, cough, fatigue, fever, high temperature, runny nose, sore throat) Each of the above has no reason to isolate I confirm we will each use your hand sanitiser in your porch before entry. Wearing facemasks is now optional

All fine! :)
Thank you for considering others who will visit after you.
We look forward to meeting you!

Email

This is required to make the form work

3 + 3 =

2 4 6 8

This proves you are human!