Course Booking Form

PLEASE ENSURE YOU HAVE BOOKED A COURSE FROM THE COURSE BOOKINGS MENU, PRIOR TO COMPLETING THIS FORM

In order to complete your booking: you must fill out and submit this form to us. A new form is required for every course you book. All information submitted to us is kept private and confidential.

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Please tick this box to confirm that you have read and agree with MR. Courses Terms and Conditions:* 

Coronavirus Update
Dear Candidate,
As you are aware of the outbreak of coronavirus in China and its spread to other countries, including the UK. We at MR Dental are following UK government advice and guidance.

We are sharing regularly with our staff and guests/ candidates information on the outbreak and advice on how to keep themselves and others safe and well.
We would like our guests/ candidates to be equally well informed and prepared. We therefore ask you to read carefully the advice below.
If you think you may have the virus. If you get a cough, a high temperature or feel short of breath within 14 days of returning from China,
Hong Kong, Thailand, Japan, Republic of Korea, South Korea, Iran, Italy, Taiwan, Singapore or Malaysia:
- Stay indoors and avoid contact with other people
- Call NHS 111 to tell them of your condition
You should follow this advice if you have returned from Wuhan or Hubei Province, even if you do not have symptoms of the virus.
If someone tells you they think they may have the virus
- EITHER leave the room immediately OR ask them to go to an area away from others.
- Maintain a safe distance of at least two metres from the potentially infected person.
- Tell them to seek medical advice by calling the NHS on 111
- Notify our Admin on 01483 773282 and tell them to stay where they are
Keep up-to-date with the latest information and guidance
This information is based on the latest guidance from Public Health England as of 24th February 2020.
If you have any questions, please visit www.gov.uk/coronavirus.
If you have any questions about this guidance or concerns about coronavirus, please contact NHS on 111.

The latest government guidance can be found at www.gov.uk/coronavirus.
Best wishes,
Admin Staff

HEALTH DECLARATION
I, * declare that during the past 14 days I have no fever, cough and shortness of breath or similar symptoms of flu.
If the said declaration is false, I shall be responsible for any disruption, delay, claims, and expenses/fees/fines caused directly or indirectly by my false declaration.
Please Note and be Aware that it may be a criminal offence not to notify the regulatory bodies under the Public Health (Control of Disease) Act 1984.