Risca Circuits Booking Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

21st June 2021

Name *

Address *

Email address *

Phone number *

You can only attend training if you are fit and well and have not had any symptoms associated with Covid-19 in the last 14 days (high temperature, persistent cough, fever, loss of taste or smell) please tick the box below to confirm you are symptom free. *

I confirm

Required

You can only attend training if you are not self-isolating. If you have been in contact with anyone who has had Covid-19 and have been told to self isolate, or if you have travelled from a country in the last 14 days that requires you to self-isolate, please do not attend training even if you are symptom free. *

I confirm

I understand that during the training session I will be expected to maintain 2 metre social distancing throughout. *

Yes

I understand that my details will be kept for 21 days & would be obliged to pass it to Welsh Government an approved Test, Trace & Protect authority if requested *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms