Dalpoon Academy Student Covid Questionnaire

Please complete and return this questionnaire prior to attending any classes. 

DalPoon Academy COVID Form





















































Reminder if any of these answers change it is your responsibility to inform your instructor or COVID-19 club officer


If you have answered “YES” to any of the questions above or have indicated to us that you have symptoms of COVID-19
you should not attend your club. You are prohibited from entering or using the grounds / facilities and advised to seek
professional medical assistance. NOTE: When in the club, please adhere to our on-site procedures regarding infection

control, i.e. social distancing, hand washing / hand sanitising and general coughing / sneezing etiquette

Prior to submitting this application, we would also like to note that if you are on the vulnerable persons list, you are kindly advised to see your GP in order to continue practicing/ teaching. As a guidance, so far the meaning of vulnerable in relation to COVID-19 is:

  • are 70 or older
  • have a lung condition that's not severe (such as asthma, COPD, emphysema or bronchitis)
  • have heart disease (such as heart failure)
  • have diabetes
  • have chronic kidney disease
  • have liver disease (such as hepatitis)
  • have a condition affecting the brain or nerves (such as Parkinson's disease, motor neurone disease, multiple sclerosis or cerebral palsy)
  • have a condition that means they have a high risk of getting infections
  • are taking medicine that can affect the immune system (such as low doses of steroids)
  • are very obese (a BMI of 40 or above)
  • are pregnant










Wilstead

Master Malcolm Campbell

EVERY Tuesday

18:45 - 20:00

Wilstead Village Hall

Cootton End Road

Wilstead

MK43 9EU

Contact
Newport Pagnell

Master Dave Roughley

EVERY Tuesday

17:45 - 18:45

Portfields Community Center

50 Wordsworth Ave

Newport Pagnell

MK16 8SB

Contact
Wixams

Master Nick Hunter

EVERY Monday

18:30 - 20:00

Wixams Village Hall

55-160 Brooklands Ave

Wixams

MK42 6BE

Contact
Thurleigh

Trevor Buck

EVERY Monday

17:30 - 19:30

Thurleigh Village Hall

27 High Street

Thurleigh

MK44 2DB

Contact
Bedford

Master Dave Roughley

EVERY Monday

16:00 - 17:00

Bedford Athletic Rugby club

Wentworth Dr

Bedford

MK41 8QA

Contact
Berry Wood

Master PQ and Sam Q

EVERY Tuesday

18:30 - 19:30

Wootton Community Centre

Harris Way

Wootton

MK40 4TX

Contact
Jedburgh

Master Andy Young

EVERY Thursday

17:00 - 18:00

Jedburgh Grammar Campus

Priors Rd

Jedburgh

TD8 6HH

Contact