Return Health Declaration - Divers
As we look to return to training after the recent national lockdown, please could you complete this short, mandatory declaration.

The purpose of this health screen form is to inform and make you aware of the risks involved in a return to training. For swimmers under the age of 18, parents/guardians should complete this form and tick the boxes on behalf of their swimmer. By sending this form, they are confirming that all questions have been answered in relation to their swimmer and that the swimmer has read or understands the new protocols and procedures that have been put in place and the risks involved in returning to train.

By completing this form you consent to the club using personal data for the protection and safeguarding of your health as well as safeguarding wider public health in response to the impact of COVID on club training activities. Please note that the data collected on this form is for this purpose only. There will be no unauthorised sharing of this data and it will be deleted after it has served its purpose.

As a reminder, if your swimmer does have any other symptoms (no matter how mild) which may be connected to another virus or bacterial infection, please allow 48 hours after the symptoms have gone before returning to training in order to protect all swimmers, coaches and volunteers.

If you have any questions regarding this form, please email covid.maidstonesc@gmail.com.

Many thanks,

Carole Murphy
Lead COVID Officer
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I consent to MSC collecting my personal information for the purpose stated above. *
Parent/Guardian's Full Name *
Swimmer's Full Name *
Squad *
Q1. Have you had a confirmed COVID infection or any symptoms (fever • new, persistent, dry cough • shortness of breath • loss of taste or smell • diarrhoea or vomiting • muscle aches not related to sport or training) in keeping with COVID in the last three months? *
If 7 days post recovery and no symptoms then a gradual return to exercise is permissible but should persistent symptoms of breathlessness on exertion then you should consult your usual medical practitioner.
If yes, please provide details.
Q2. Have you had a known exposure to anyone with confirmed or suspected COVID in the last two weeks? (e.g. close contact, household member) *
You will not be allowed to train until you have self-isolated for 10 days.
If yes, please provide details.
Q3. Do you have any underlying medical conditions? (examples include: chronic respiratory conditions including asthma; chronic heart, kidney, liver or neurological conditions; diabetes mellitus; a spleen or immune system condition; currently taking medicines that affect your immune system such as steroid tablets) *
If you have an underlying medical condition that makes you more susceptible to poor outcomes with COVID (including age 65+) then you should consider the increased risk and may want to discuss this with your usual medical practitioner.
If yes, please provide details.
Q4. I have sought medical advice *
If yes, please provide details.
Q5. Do you live with or will you knowingly come in to close contact with someone who is currently medically vulnerable if you return to the training environment? *
This is an individual call but awareness of risks and the appropriate precautions should be taken.
If yes, please provide details.
Q6. Do you fully understand the information presented in this mandatory form and email, and accept the risks associated with returning to the training environment in relation to the COVID pandemic? *
If no,  the information should be explained again and if they still are not aware then they should be advised not to train.
Q7. I am able to train *
Q8. I understand that it is my responsibility to inform the Lead COVID Officer if my answers to any of the health questions change after I have submitted the form and that I should NOT attend another training session until I have permission from the Lead COVID Officer. *
Q9. I agree that if the Government, Swim England or any other relevant guidance changes I will adopt and follow that guidance as directed by Maidstone Swimming Club. *
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