COVID-19 Indemnity Form

Name *

First

Last

Age *

Gender *

ID Number *

Contact Number *

Email Address

Physical Address

Have you been in contact with anyone who has displayed flu like symptoms? *

Yes
No

Have you had a cough in the last 14 days? *

Yes
No

Have you had a sore throat over the last 14 days? *

Yes
No

Have you experienced breathing difficulties in the last 14 days? *

Yes
No

Have you lost your sense of smell or taste over the last 14 days? *

Yes
No

Have you been in contact with someone who has tested positive for Covid-19 or someone who is awaiting test results within the last 14 days? *

Yes
No

Have you been vaccinated against Covid-19? *

Yes
No

If yes, please provide vaccination date:

The health & wellbeing of our clients & staff is at the heart of our brand & we look forward to delivering the best products & services to you. We are Covid-19 compliant & follow strict safety procedures and checks for your peace of mind. I acknowledge the contagious nature of the Corona Virus/Covid-19 & that the CDC & many other public health authorities recommend practicing social distancing and sanitising. I further acknowledge that Zanya Spa & Wellness has put in place preventative measures to reduce the spread of Covid-19.

I AGREE