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