Orienteering Navan - European Week of Sport 2021
All programme/course participants must complete and submit the following form before the programme start date.

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Meath Local Sports Partnership
Participant Details
Full Name *
Age Group *
Names of family members attending -please put age beside each child name
Email *
Phone number *
Address *
Declaration and Release
I hereby give my full permission for the use of our name, picture, image, likeness, actions, voice, video footage  that I am featured in, in whole or in part, individually or in conjunction with other images or videos, as part of my participation in this programme and by all submissions of reports, of media and for purposes of promotion through www.meathsports.ie and associated programmes. *
I understand that the information I provide in this form will be used for monitoring and evaluation purposes and will be shared with other stakeholders for the same purpose. I understand that my name will not be shared as part of this process. *
Readiness to Participate
We have no health related reasons (medical, mental or physical) which would prevent us from participating in this programme. *
Required
I certify that we are medically, mentally and physically fit to participate in this programme. *
Required
COVID-19 Questionnaire
AS PART OF MEATH LSP`S RESPONSE PLAN TO THE COVID 19 CORONAVIRUS AND REDUCING THE INFECTION SPREAD, YOU ARE REQUIRED TO COMPLETE THE SELF DECLARATION FORM BELOW.
YOUR CO-OPERATION AND SUPPORT IS APPRECIATED.

Do you or any of your family attending have a fever – high temperature or chills? *
Required
Do you or any of your family attending have a cough?                                                                                           *
Required
Do you or any of your family attending have shortness of breath or breathing difficulties?                           *
Required
Do you or any of your family attendinghave any cold or flu like symptoms (runny nose, sore throat, headache)?         *
Required
Have you or any of your family attending been in close contact with a confirmed case of COVID 19 – Coronavirus in the last 14 days? (Close contact is defined by the HSE as spending more than 15 mins face-to-face contact within 2 meters of someone who has tested positive for COVID 19).     *
Required
Did you or anyone in your household travel abroad in the last 14 days? *
Required
Have you or anyone from your family attending being tested positive for COVID 19? *
Required
Has anyone in your household tested positive for COVID 19?   *
Required
Have you or any of your family attending been asked to quarantine/self-isolate on the advice of medical personnel/agency? *
Required
I confirm that I have truthfully answered the questions above. I realise that based on answers provided, I or members of my family may be asked to remove myself from participating in the programme. *
Required
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