Covid-19 Child
We have created this form to support the safety of our karate students. The information you provide is confidential,however it is necessary to keep our dojo safe. Thank you and we highly appreciate your understanding.

Student Details
We have created this form to support the safety of our karate students. The information you provide is confidential,however it is necessary to keep our dojo safe. Thank you and we highly appreciate your understanding.

Child First Name *
Child Last Name *
Child Date Of Birth *
Child COVID-19 Vaccination *
Parent/Guaridan First Name *
Parent/Guaridan Last Name *
Relation to Applicant *
Address *
State *
Zip *
Country *
Home Phone *
Parent Mobile Phone Number *
Student Email *
Parent Email *
Parent/Guardian Vaccination *
Parent/Guardian Vaccination *
Parent/Guardian Vaccination *
Parent/Guardian who will have contact with Dojo members (drop-off, pick-up)
If recorded temperature of your child is over 37.5, please note you will have to reschedule training
Have you been unwell in the last 14 days? *
Including, but not limited to fever flue like symptoms*muscle aches and pains cough or any cold symptoms experienced, difficulty breathing, loss of sense of smell, diarrhea, fatigue or headache.
Have your child had exposure to anyone with ANY of the flue symptoms *
Including, but not limited to fever flue like symptoms*muscle aches and pains cough or any cold symptoms experienced, difficulty breathing, loss of sense of smell, diarrhea, fatigue or headache.
Have your child been tested for Covid-19, and tested positive. *
Or have been tested but do not yet have a confirmed negative result?
Have your child been in contact with a suspected Covid-19 positive person in the last 14 days? *
Have your child been at a location/ facility recently linked to a Covid cluster? *
Have your child travelled interstate from any known COVID hot spots in the last 14 days? *
(E.g. Victoria, NSW)
Have your child/children recently conducted any personal travel in the last 14 days?
Or had exposure to anyone who has travelled overseas or domestically via air or sea (including cruise ships)
If you have ticked yes to any of the above
and/or recorded a temperature reading of >37.5 degrees on two measurements at our dojo entrance, for the safety of our staff and students and yourself we recommend you seek GP/EMERGENCY DEPARTMENT opinion and you can make up your classes later.

Any information collected will be subjected to our Privacy Policy. I understand that, in the period of the COVID-19 Pandemic, that the close individual contact required, to administer a medically guided Aesthetic procedure increases the risk of spread of infection of the virus.

Kyokushin Karate Port Macquarie Dojo is following Covid-19 government rules, has a Covid-19 Policy and registered as a Covid safe business to reduce the risk to the absolute minimum, but a 100% guarantee cannot be given.

I acknowledge that i have been warned and accept this risk.
The following ‘in class’ mandatory safety requirements will apply: *
  • A hand cleaning station where all persons entering the class area will clean their hands.
  • A requirement that the temperature of all persons entering be tested via a forehead thermometer - persons outside of the temperature range will not be able to enter.
  • A ‘single user’ rule for all equipment i.e. focus pads, gloves etc may only be used by the one person in any class – all equipment will be appropriately cleaned after usage.
  • When so permitted, by Government regulation, partner training can occur. Under this Policy a training partner must remain as the same person for the duration of the class (i.e. no changing training partners).
  • Spectators to your martial arts class are not allowed.
  • Where possible classes will have a clearly sign posted separate entry and exit area.
  • When conducting back to back classes, once classes are finished there will be no entry from those attending the next class until all those in previous class have left.
  • Instructors will ensure that the following items form part of my ‘safety supplies’:
    • o hand sanitizers, disinfectant mops, microfiber cloths, gloves - rated safe, paper towels.
  • Instructors will ensure that cleaning and sanitizing will occur before and after class and, where required during class – particular attention to be paid to bathrooms and entry doors.
  • Instructors will ensure that any chairs in the training area are spaced a minimum of 1.5. metres apart.
  • Parents dropping their children to class will not be permitted to stay in the class, if they need to stay they must wait outside.
  • MUST WEAR SHOES OR SLIPPERS entering dojo!
  • While training is limited to small groups (Level B of the AIS Framework), your sport should:
    • Encourage participants to follow the approach to training of "get in, train, get out" to minimise unnecessary contact with change rooms, bathrooms and communal areas. This approach involves participants showering with soap and getting dressed to train at home and showering at home on completion
    • Ensure training aligns with the minimum standards set out in the AIS Framework and local State/Territory restricted activity laws.
      • Apply a graded return to training/competition for participants to mitigate injury risk from sudden increases in training loads.
      • Spectators to your sports sessions are not allowed.
      • When so permitted, by Government regulation, partner training can occur. Under this Policy a training partner must remain as the same person for the duration of the session (i.e. no changing training partners).
      • Where possible, sessions will have a clearly sign posted separate entry and exit area.
      • When conducting back to back sessions, once training sessions are finished there will be no entry from those attending the next session until all those in the previous session have left.
      • Coaches will ensure that the following items form part of my ‘safety supplies’:
        • hand sanitisers, disinfectant mops, microfibre cloths, gloves - rated safe, paper towels.
      • Coaches will ensure that cleaning and sanitising will occur before and after each and, where required during the session – particular attention to be paid to bathrooms and entry doors.
      • Parents dropping their children to sessions will not be permitted to stay, if they need to stay they must wait away from the training area.
Temperature Testing *
  • As a preventative measure all ‘Covid Safe Martial Arts Schools’ shall have in place a formal, proactive testing procedure.
  • Temperature screening shall ensure that all persons with a temperature of 37.5°C or more are restricted from entry into the class.
  • Temperature screening will be conducted at the entrance to the class by the designated screener.
Does your child take antigen rapid test at school or at home?



I agree to inform dojo of the positive test result. *
I agree to inform dojo being casual or close contact *
Print signature name *


Please kindly find more information below:
Stay Informed
  • Stay informed on the latest developments about COVID-19. Up to date information is available at: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert.
  • Monitor news updates regarding local events and gatherings.
  • Follow current advice given by your national and local public health authority and your employer on how to protect yourself and others from COVID-19.
Key Messages for COVID-19
  • You can help protect yourself, your family, your workplace and your community
  • Practice regular hand hygiene
  • Practice social distancing
  • Practice respiratory etiquette
  • Remember that COVID-19 can be transmitted by droplets that can be passed from hand to hand including handshakes.
  • Seek medical advice, remember to call first, and inform your workplace if you have symptoms
  • For further information go to:
    • Your local public health unit
    • https://www.healthdirect.gov.au/coronavirus
    Handwashing
    • Hand rub: video
    • Hand wash: video
    • This is especially important after going to the toilet, blowing their nose and before
    What About Masks?
    • Wearing a facemask in public won’t help to protect you from infection.
    • Only wear a mask if you are sick with symptoms that might be due to COVID-19 (especially coughing) or looking after someone who may have COVID-19.
    • There is a shortage of masks and we need to save them for use when they are needed for sick people or for those looking after them.
    What If I Develop Symptoms of COVID-19?
    • If you develop symptoms such as fever, dry cough, sore throat and fatigue:
      • Stay at home and practice standard infection control precautions.
      • Seek medical advice, it is important to call ahead first.
    • Go to healthdirect.gov.au
    • Call the National Coronavirus information and Triage Line (1800 020 080) or call your usual care provider.