Franklin United Level 2 Health Declaration

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In order to meet the strict COVID-19 criteria set by the government for playing sport during Level 2, we require all players to complete this form.

Your Name *

If you are a parent completing this form on behalf of your child, please provide the name of your child/children below

In the last 14 days have you/your child(ren) experienced any of the following symptoms - cough, high temperature, shortness of breath, sneezing, runny nose, sore throat or loss of sense of smell? *

Yes

In the last 14 days have you/your child(ren) been in contact with anyone experiencing any of the following symptoms - cough, high temperature, shortness of breath, sneezing, runny nose, sore throat or loss of sense of smell? *

Yes

In the last 14 days have you/your child(ren) been in contact with anyone that has been infected by or exposed to COVID-19? *

Yes

If you answered yes to any of the three questions above please do NOT attend training, self-isolate and follow Ministry of Health guidelines.

Declaration *

Yes

I understand that I should stay at home if I am unwell

I agree that when I arrive at training I will report in to the field marshall

I understand that I am to stay 1 metre apart from my training partner(s) and staff

If I begin to feel ill, I agree to immediately tell my coach

I agree to adhere to good hygiene practices including cleaning my training clothes and equipment

Submit

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