Questionnaire - recording at Axis Ballymun All participants must complete the following form before attending DYT activities at The Axis BallymunMember Name* First Last Age*Parent / Guardian ConsentParent / Guardian oversight of this questionnaire is required for members under 18. Please discuss the questionnaire with your member and sign below. Thank you!Parent / Guardian Name* First Last Parent / Guardian Contact Phone Number*QUESTIONNAIREIf the answer is Yes to any of the below questions, you are advised to stay at home and seek medical advice. There will be other chances to join events at future dates.Have you visited any countries outside of Ireland (including Northern Ireland) in the last 14 days?* Yes No Are you experiencing any flu-like symptoms (cough, fever, high-temperature, sore throat, runny nose, breathlessness) or symptoms of Coronavirus / Covid-19 now or in the past 14 days?** Yes No Have you been diagnosed with a confirmed case of, or a suspected case of, Coronavirus / Covid-19 or flu like symptoms in the last 14 days?* Yes No Have you been in contact with someone with a suspected or diagnosed case of Coronavirus / Vovid-19 in the last 14 days?* Yes No Is a member of your household self-isolating?* Yes No Are you in a period of self-isolation and/or cocooning under the current Health Policy Rules?* Yes No Have you been advised by your doctor that you are in an at risk group?* Yes No If yes, please liaise with your doctor (and parent / guardian) re returning to the studio.SIGNED:* Today's Date* DD slash MM slash YYYY CAPTCHA