Malahide Sea Scout Health Declaration Form

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Email *

FIRST NAME OF MEMBER *

SURNAME OF MEMBER *

Section

Have you in the past 14 days been in close contact with a person who has been diagnosed with or suspecting of having Covid-19 *

Yes

Have you or a member of your household returned from travel abroad in the past 14 days *

Yes

Have you had any of the following Covid 19 symptoms in the past 14 days: Fever (high temperature - 38 degrees Celsius or above). Cough - this can be any kind of cough, not just dry. Shortness of breath or breathing difficulties. Loss or change to your sense of smell or taste *

Yes

If you have answered YES to any of the above questions and have not received a negative Covid 19 test result you should not attend any meetings or activities with Malahide Sea Scouts.

DECLARATION: I have no reason to believe that (I) my child (have) has an infectious disease and I have followed all medical and public health guidance with respect to exclusion of (myself) my child from sporting and educational activities. *

I confirm

Required

Name (Parent/ Guardian name for under 18s): *

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