COVID-19 Questionnaire and Declaration for The Italian Academy

Dear student, following the Italian government's guidelines on safeguarding against COVID-19, we kindly ask you to fill in this questionnaire. Compliance with the safety measures required by the Italian government is mandatory in order to participate in our on-site courses. Students who have not completed this questionnaire will not be allowed to enter the school.
Name
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
I hereby declare that*
- Select All
- 1) In the past 14 days, I have not resided in one of the countries for which fiduciary isolation is required upon arrival in Italy;
- 2) In the past 14 days, I did not experience any of the following symptoms: Fever > 37.5° C (>99.5° F); Breathing difficulties; Persistent cough; Changes in taste and / or smell;
- 3) In the past 14 days, I did not have any contact with subjects, including family members, affected by COVID-19;
- 4) I have never been affected by COVID-19 and I never tested positive without adequate clinical / laboratory follow up analysis;
- 5) I have a medical certificate to prove my healing from COVID-19 (only applicable in case of a positive answer to point 4.)
The subscriber hereby undertakes to communicate to The Italian Academy any changes relating to the declarations signed in this declaration.
Travel documentation for non-EU students: Please upload here your flight ticket to confirm the date in which you have entered the Shengen area and/or to confirm which country you have resided in during the last 14 days.
Drop files here or
Before arriving in Sicily:
1. Download the "Sicilia Sicura" application and register on the website.
2. Download the "Immuni" application and install it.
3. Take The Italian Academy on-line level test
4. If you booked an accommodation with us, send us your mobile phone number and your arrival details.
When around Siracusa and Sicily:
1. Maintain at least 1-meter distance at all times;
2. Always wear a mask indoors (school, shops, offices etc.);
3. Wear a mask outdoors if safety distance cannot be guaranteed;
4. Wear a mask when entering a restaurant or café and take it off only when you are at the table.
At the school:
1. Temperature check upon entrance
2. Daily sanitizing and after-class cleaning
3. 1-meter safety distance requirement
4. Always wear a mask indoors (classroom, reception, common areas)
5. Wash your hands frequently and/or use hand-sanitizer gel provided at reception
Consent to the processing of personal data (Legislative Decree 196/2003 and EU Regulation No. 2016/679)*
I agree to The Italian Academy privacy policy.
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COVID-19 Questionnaire and Declaration for The Italian Academy