Health-Check Arrival form

Name*

Please enter your full name

Testing requirement*

I will undergo a rapid Covid antigen test upon arrival, and a self-test on the 4th day, supplied by Arhanta Yoga.

Yes, I understand and agree to this requirement.
No, I have an issue with this requirement.

Currenth Health information*

Are you, or is your family/partner, currently experiencing any of the following symptoms:

Coughing
Fever
Shortness of breath
Loss in smell or taste
Symptoms of the common cold such as running nose or sneezing
No

Prior Health Information - Covid-19*

Have you had and/or recovered from the Covid-19/Corona disease in the last 14 days?

Yes, confirmed by testing. But I have recovered and have no symptoms anymore for at least 7 days.
Yes, self diagnosed. (not tested)
Maybe, I have/had symptoms within the last 7 days.
Maybe, I had symptoms but not anymore for at least 7 days.
Maybe, I have been in direct contact with someone who had symptoms in the past 14 days.
No. I have not had the Corona / Covid-19 disease.
No. I (might) have had Corona before the 10th of October 2021 and recovered fully.

Risk:*

Are you part of any risk group?

Yes, I have a medical issue / medical history
Yes, but only due to age (over 50).
No.

Emergency Contact

Please fill in the name and phone number of the person we should contact in case of an emergency. (including country code if outside The Netherlands)

Additional details

Please let us know of any additional details that could be useful!
For example; arrival time expectation, or medical history.

Declaration*

Please mark all of the following statements, or contact us immediately in case you disagree with any of them.

Yes I am able and willing to follow recommended safety measures by the government and the Arhanta team, explained in the Corona protocol: https://www.arhantayoga.org/wp-content/uploads/2021/10/October-Covid19-Protocol.pdf
Yes I understand the risk involved in coming together as a group to study intensively, live together and be in contact with each other. I understand that in event of developing any covid-19 symptoms during the course or if tests show an infection, I will have to self-isolate at my own cost until I am symptom-free and have tested negative for Covid-19. I confirm that I have filled in this form truthfully and will update Arhanta Yoga Ashrams in case any of the provided information changes.
I confirm that I have read and agreed on the Rules & Regulations, Refund policy, terms & conditions and liability waiver of Arhanta Yoga. https://www.arhantayoga.org/general-conditions/ + https://www.arhantayoga.org/Liability-waiver.pdf

Sign*

Type your name:

September 2021 - Safety requirements and rules