Softball W - Declaration Form COVID 19

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Name *

Have you travelled to and from any country(ies) within the last 14 days? *

Yes

Within the last 14 days, have you had contact with a COVID-19 confirmed or suspect case, or a person issued with a Quarantine Order (QO) / Leave of Absence (LOA) / Stay-Home Notice (SHN)? *

Yes

Within the last 14 days, have you had contact with a member in your household who is unwell? *

Yes

Are you feeling unwell or having any symptoms (such as fever, cough, muscle ache, joint pain, headaches, sore throat, runny nose, shortness of breath, change in smell, change in taste, diarrhoea)? *

Yes

I declare that I have provided the above information truthfully and to the best of my knowledge

Yes

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