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Osaka Kwai Judo Club - Indemnity
Athlete Indemnity form - TO BE COMPLETED BEFORE EACH SESSION
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* Indicates required question
Date of Session (not to be completed more than 48hrs in advance)
*
MM
/
DD
/
YYYY
Judokas Name
*
Your answer
Contact Details Email
*
Your answer
Emergency contact Name (Contact1)
*
Your answer
Contact Details - Phone Number
*
Your answer
Are you currently Diagnosed with or believe you may have Covid-19?
*
YES - Please not NOT attend the club
No - Continue to next Question
Do you have any of the following Symptoms: If yes - PLEASE NOT attend club.
*
High Temperature
A new or continous cough
Loss or change to your sense of taste of smell?
New Unexplained Shortness of Breath
None of the above - continue to next Question
Required
Have you been in contact with a Covid-19 confirmed or suspected case in the previous 14 days?
*
Yes - Do NOT attend the club
No
Maybe - Do NOT attend the club
Parent/Guardians/Seniors Electronic Signature
*
Your answer
Date signed
*
Your answer
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