contents of sign up form:
SCKF Godo Keiko, 3/13/22 9am at Sho Tokyo Dojo (La Habra location)
This practice is for currently registered SCKF members. All participants must
be fully vaccinated and masked. You must be pre-registered for this practice;
no drop-ins allowed.
The address is 2031 Emery Ave, La Habra 90631
(see
photo of the entrance)
Enter: last name, first name, dojo, rank
COVID-19 Questionnaire
Symptoms: you or anyone in your household, within 10 days prior to the practice:
- fever (over 100.3 degrees)
- cough
- sore throat
- body ache, headache
- nausea, vomiting, diarrhea
- shortness of breath or difficulty breathing
- fatigue
- chills
- nasal congestion
- confusion, brain fog
- loss of taste or smell
Exposure: you or anyone in your household
- currently have COVID-19 or are subject to any specific order to
self-quarantine or self-isolate
- had close contact* with anyone with COVID-19 or its symptoms within 10
days prior to the practice
Condition:
- lack of stamina while wearing a mask (e.g. cannot do 50 hayasuburi)
- taking medications to suppress fever, cough, or congestion symptoms
The above will be double checked during sign in for the practice. If you
answer yes to any of the above, we will ask you not to participate in the
practice.
*Close contact means having been within 6 feet of a COVID-19 positive or
symptomatic person for a cumulative total of 15 minutes or more over a 24-hour
period starting from 2 days before illness onset (or, for asymptomatic
individuals, 2 days prior to test specimen collection) until the time the
individual is isolated, or had direct contact (e.g. being coughed on).
If you answer yes to any of the above items, we ask that you not sign up for
this practice (close this form now).
Answer to all: (must be no to continue)
I am fully vaccinated against COVID-19, and have shown proof to my dojo
Answer: (must be yes to continue)
I agree to notify SCKF if I or anyone in my household develops COVID-19
symptoms within 72 hours after the practice or tests positive for COVID-19
within 7 days after the practice (your privacy will be maintained).
Answer: (must be yes to continue)
I am a current registered member of SCKF, and have printed, signed, and
submitted the latest AUSKF waiver form to my dojo
Answer: (must be yes to continue)
SUBMIT