I declare, responsibly:
1. That during the last 10 days and at this time: I do not have any symptoms compatible with COVID-19 (fever, cough, difficulty breathing, malaise, diarrhea ...) or any other infectious picture. I have not been positive for COVID-19 or have lived with people who are or have been positive. I have not been in close contact with anyone who has tested positive for COVID-19 or who has had symptoms compatible with this disease. 2. That in relation to the following diseases: Serious respiratory diseases that require medication or ventilatory support devices. Serious heart disease. Diseases that affect the immune system (for example, those people who need immunosuppressive treatments). Poorly controlled diabetes. Neuromuscular diseases or moderate or severe encephalopathies. (Select one of the two options) * 3. That I will use the mask inside the center, unless the use of the mask has any contraindications for me (people with respiratory problems, who have difficulty removing the mask on their own or who have behavioral disorders that make its use unfeasible). 4. That I will take the temperature before I leave home (or wherever) to go downtown Eòlia ESAD and that, in the event that I have a fever or have any of the symptoms compatible with COVID-19, I will not attend.
5. That I know the obligation to inform the center of the occurrence of any case of COVID-19 in my family / close environment and also to maintain close contact with the center in the event of any incident.
6. That I will attend my referral CAP in case I have symptoms in order to request a PCR test, and I will stay home until I have the test results. 7. That I have read the regulations published by Eòlia ESAD and I undertake to comply with the instructions specified therein. VACCINATION INFORMATION:
Because students with the full vaccination schedule will not have to quarantine if a positive case is confirmed in the bubble group, we need to know your vaccination status.
Have you completed the COVID-19 vaccination schedule? * If so, please attach the EU COVID DIGITAL CERTIFICATE below:
And, for the record, for the purposes of my incorporation into the center
In application of the General Data Protection Regulation EU-2016/679 and in compliance with the provisions of Organic Law 3/2018, of 5 December, on the Protection of Personal Data and Guarantee of Digital Rights, Nova Eòlia SL informs you that the data included will be incorporated and processed in a computerized file for the exclusive use of the center, its purpose being to manage the educational action, on the occasion of the security protocols for the COVID-19 pandemic. Your data will not be communicated to third parties, except by legal obligation. In fulfillment of the duty of collaboration with the Department of Health to deal with the COVID-19 pandemic, it is necessary to assess the presence of staff, faculty and students with conditions of special vulnerability in relation to virus infection. It is especially important to protect the health of the community in relation to SARS-CoV-2 coronavirus infection.
It is also reported that you can exercise any right established by law (access, rectification, cancellation or complaint) by contacting Nova Eòlia SL at the address c / Casp, 82 baixos (08010 Barcelona) or in a email to firstname.lastname@example.org. Nova Eòlia, SL guarantees the absolute confidentiality of your data in accordance with the relevant provisions of current legislation, which the center strictly complies with. Signature *
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