Affordable Driving School COVID Safety Waiver

Student Name

First Name Last Name

Parent/Legal guardian Name

First Name Last Name

Email

example@example.com

Phone Number

Area Code Phone Number

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Are you experiencing any of the following symptoms? *

	Yes	No	Notes?
Dry cough
Fever
Shortness of breath
Loss of taste or Smell

Answer the following questions *

	YES	NO
Have you or any immediate family members been diagnosed or exposed to someone infected with COVID-19?
Do you have any pre-existing health conditions i.e Asthma, other respiratory problems?
Will you have a mask to wear while driving?
If you or immediate family have been diagnosed with COVID-19 you will be asked to provide a doctors note clearing you to drive with us, will that be an issue?

What is your current temperature? *

Temperature must be taken within 24 hours of appointment, FYI we will be required to take again upon arrival.

Any questions or comments for your Instructor/Tester?

Steps to be taken to protect others:

If you're experiencing any of the symptoms above, get medical attention immediately.
Stay home if you're sick.
Due to the close proximity of student and instructor/tester please be advised we strongly encourage you to wear a mask.
Instructors/testers have to sanitize vehicles before and after each lesson.
Office has hand sanitizer and hand washing facilities.
Once you enter our facility you will be asked to wash your hands.
Please be proactive in taking the steps to keep yourself and our staff safe, if you arrive at our facility and are running a fever above 100.2 you may be asked to reschedule and it will be considered a late cancellation. $45 will be assessed before you can reschedule.
Please show up on time for appointments. If you are more than 5 minutes late for a license test you will be asked to reschedule your appointment. Driving lessons allow a 15 minute grace period before it is considered a late cancellation.

We look forward to seeing you soon and appreciate your cooperation and patience during this time. Our goal is to provide you with quality service in a safe caring environment for you and your family.

Signature *

Coronavirus Safety Measures Checklist