Bective Ranges FC Mini's U8s Declaration Form

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IRFU PRE-RETURN TO RUGBY PERSONAL ASSESSMENT DECLARATION
Mini's/Youth's Training in Donnybrook
May 2021

Should you answer YES to any of the below questions you should NOT attend your club and before you return you should follow appropriate medical advice and guidelines.

Email *

Name of Player *

Team/Group *

Enter Date of Training *

YYYY

Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2m for more than 15 minutes accumulative in 1 day)? *

Yes

Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *

Yes

Have you been advised by a doctor to self-isolate at this time? *

Yes

Are you suffering now, or have you suffered any the following symptoms in the past 14 days? *

None of the below

Cough

Breathing difficulty

Fever/High temperature

Sore Throat

Runny Nose

Flu like symptoms

Rash

Loss of Smell/Taste

New Skin Rash

New Gastrointestinal Symptoms

Flu Like Symptoms

Have you returned to Ireland from another country within the last 14 days? *

Yes

If you answered 'Yes' to the question above, what country did you visit & when did you arrive back in Ireland?

I confirm that I have not travelled from another country in the past 14 days , that I have not been in close contact with anyone who has been outside of the country in the past 14 days, that I have not been in close contact with anyone who is in self-isolation in relation to COVID-19 in the past 14 days, that I am not suffering from any COVID-19 symptoms nor do I believe for any reason that I have contracted the virus. I commit to advising management and excluding myself if this situation changes, (i.e. if at a point in the future, I would answer “yes” to any of the above questions). *

I confirm the above statement

Required

I confirm I have read and understand the guidelines set out by the IRFU in the below link. https://d2cx26qpfwuhvu.cloudfront.net/irfu/wp-content/uploads/2020/06/05141528/03-IRFU_ReturnToRugby-Guidelines-Players.pdf *

I confirm the above statement

Required

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