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Oxigym Health Check-list
Form to be filled in before entering the gym.
First Name
Last Name
Phone Number
Home Address
E-mail
Are you suffering from flu-like symptoms / symptoms of COVID-19?
Yes
No
Are you experiencing any difficulty in breathing / shortness of breath?
Yes
No
Are you experiencing any fever-like symptoms?
Yes
No
Do you experience any of the following symptoms: body aches, loss of smell or loss of taste, nausea, vomiting or fatigue?
Yes
No
Are you in good health?
Yes
No
Have you or any person who you have been in contact with, travelled outside your town / district / province, within the last 14 days?
Yes
No
Have you been in contact with anyone diagnosed with COVID-19?
Yes
No
Date
Place
Condition of Entry: We hereby agree that I enter/exercise in or about the premises of the Oxigym ("premises") including other unimproved areas at my own risk. It is a condition of my occupation of the premises that I specifically agree and accept that the company and/or each and any of its respective subsidiary and associated companies, and their respective members, employees, contractor, sub-contractors, agents, workmen or representatives (hereinafter jointly and separately referred to as the "company") shall not be responsible for any accident or bodily injury to any person or loss of or damage to property brought by me upon the premises regardless of whether such injury, loss or damage results from the negligence of the company or from any other cause whatsoever. I accept the aforesaid condition of presence and will agree to be bound by them. I indemnify (where more than one person, jointly and separately) the company against any claim by me, including especially any minor or disabled person in connection with his/her occupation of or his/her presence or the presence of his/her property on or about the premises, including specifically without being limited thereto, any claims arising from injury to such person and/or loss of or damage to his/her property as aforementioned and from any cause whatsoever.
I accept the above mentioned statement!
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CONTACT US TODAY
First Name
Last Name
Phone Number
E-mail
Message
Send
Tel: 0227134481
Cell: 0711518488
dirkoxigym@gmail.com
Cubenco Business park Unit 7 main road