COVID-19 Screening Form

We trust that you and your fellow guests are following recommended protocols to limit COVID-19 exposure. With that in mind, please answer the following questions with honesty.

We feel we can contribute more to our collective wellbeing by keeping our doors open and giving people a place to step out of the stress and tension caused by current events. We are pre-screening all our guests and keeping guest numbers within recommended limits. However, we are not practicing social distancing on the Ashram grounds. Also, our Yogi residents will not be wearing masks or gloves. Instead, we have stayed home as much as possible, and take extra care to boost our immunity. You are welcome to use whatever protocols you are comfortable with. If you have any questions about the scientific data that supports our approach, please feel free to call Uma at (207) 485-1228.

Name

First Name

Last Name

Age:

Email Address

Phone Number

Emergency Contact Person Name and Phone Number

Please tell us in detail where you have spent time in the last 3 weeks. Be as specific as possible in regards to travel.

Who is the closest person/people to you who has COVID-19 symptoms or is a confirmed case?

For example: My boss, but I haven't been in contact with them for 3 weeks or there are three confirmed cases in my town.

What have you been doing to prevent your exposure to COVID-19?

Do you have any standing health issues that place you in the COVID-19 "high risk" category? If yes please explain in detail. Also add why even with this ailment you would still like to come to Sat Manav.

This includes, but is not limited to, respiratory issues, a heart condition, diabetes.

Acknowledgments

I agree to the Terms and Conditions and to follow the General Guidelines of Sat Manav Yoga Ashram.

I will not hold Sat Manav Yoga Ashram responsible in the event of any kind of injury or illness.

I understand that in the event I seem ill upon arrival or become ill during my stay I will have to leave immediately.

I have had no Corona Virus like symptoms for a minimum of 2.5 weeks.

COVID-19 Screening Form