Covid 19 Driving Lessons Form

M N PHOENIX DRIVING SCHOOL

Please complete and return on the evening before your lesson or before midday on the day of your lesson. Thank you for your co-operation.

Full Name *

Email Address *

Street Address *

City

County

ZIP / Postal Code

Mobile Number *

Lesson Date *

1. Do you have the Corona Virus? *YesNo

2. Have you been in contact with anybody that has the Virus? *YesNo

3. Have you been contact-traced, regarding the Virus? *YesNo

4. Do you have a persistent cough or a shortness of breath? *YesNo

5. Do you have a temperature of 37.5 degrees Celsius or above? *YesNo

Additional comments 0 / 300

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