Covid-19 Health Survey Please enable JavaScript in your browser to complete this form.Name *FirstLast1 - Have you or your child (if they are returning) had confirmed Covid-19 infection or any symptoms (listed below) in keeping with Covid-19 in the last five months? • Fever • New, persistent, dry cough • Shortness of breath • Loss of taste or smell • Diarrhoea or vomiting • Muscle aches not related to sport/training *YesNoIf Yes, 7 days post recovery and no symptoms then a gradual return to exercise is permissible but should persistent symptoms of breathlessness on exertion then you should consult your usual medical practitioner2 - Have you or your child (if they are returning) had a known exposure to anyone with confirmed or suspected Covid-19 in the last two weeks? (e.g. close contact, household member) *YesNoIf Yes, Not allowed to train until they have self-isolated for 14 days.3 - Do you or your child (if they are returning) have any underlying medical conditions? (Examples include: chronic respiratory conditions including asthma; chronic heart, kidney, liver or neurological conditions; diabetes mellitus; a spleen or immune system condition; currently taking medicines that affect your immune system such as steroid tablets) *Yes - please answer question 4NoIf you have an underlying medical condition that makes you more susceptible to poor outcomes with COVID-19 (including age >65) then you should consider the increased risk and may want to discuss this with you usual medical practitioner4 - If you answered "Yes" to question 3 then please provide details5 - Do you or your child (if they are returning) live with or will you knowingly come in to close contact with someone who is currently ‘shielding’ or otherwise medically vulnerable if you return to the training environment? *Yes - please answer question 6NoThis is an individual call but awareness of risks and the appropriate precautions should be taken.6 - If you answered "Yes" to question 5 then please provide details7 - Do you fully understand the information presented in the Covid19 Return To Training briefing and accept the risks associated with returning to the training environment in relation to the Covid-19 pandemic? *YesNoAdditional explanation required in this circumstance and if understanding is not forthcoming they should be advised not to train.8 - Able to Train *YesNo9 - Sought Medical Advice *YesNoIf answer is "Yes" then please contact the club seperately with a copy of the medical adviceSignature - If under 18 then parents signature is required *Typing your name in this box will be taken as a signatureDate *Email *By signing this form I consent to the club using my*/my child’s* personal data for the protection and safeguarding of my*/my child’s* health as well as safeguarding wider public health in response to the impact of Covid-19 on club training activities. I understand that the club may still have a lawful need to use this information for such purposes even if I later seek to withdraw this consent. For further details of how we process your personal data or your child’s personal data please view our Privacy Policy. The Privacy Policy can be found on the SLCSC website. MessageSubmit Come and join the community! Facebook Twitter