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Pre-training Covid-19 Health Screen
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* Required information.
Have you had confirmed Covid-19 infection in the last 5 months? *
If ‘Yes’, please provide details:
Have you suffered from any Covid-19 symptoms in the last 5 months? *
Have you had a known exposure to anyone with confirmed or suspected Covid-19
in the last 14 days *
If ‘Yes’, please provide details:
Do you have any underlying medical conditions? *
If ‘Yes’, please provide details:
Do you live with or will you knowingly come in to close contact with someone
who is currently ‘shielding’ or otherwise medically vulnerable if you return to
the training environment? *
If ‘Yes’, please provide details:
Do you fully understand the information presented in the Covid-19 Return To
Training letter and accept the risks associated with returning to the training
environment in relation to the Covid-19 pandemic? *
Swimmers Name *
I declare that the information provided is true and accurate *
Parents Name *

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