Before entering Medway Park leisure centre and track area, Medway & Maidstone AC requires all athletes to complete this questionnaire in order to minimise the risk of exposure to the spreading of Covid-19. If your health condition changes after completion of this questionnaire, please submit an updated response. Thank you.

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Medway and Maidstone Athletic Club Open Meeting - 3rd May 2021

First name *

Surname *

Telephone/mobile number *

Email *

Within the last 14 days, have you experienced a new cough that you cannot attribute to another health condition? *

Yes

Within the last 14 days, have you experienced new shortness of breath that you cannot attribute to another health condition? *

Yes

Within the last 14 days, have you experienced a new sore throat, loss of taste or smell that you cannot attribute to another health condition? *

Yes

Within the last 14 days, have you had a temperature at or above 37.8C or the sense of having a fever? *

Yes

Within the last 14 days, have you had close contact with someone who is or was sick with suspected or confirmed Covid-19? *

Yes

I confirm that I have answered these questions honestly and correctly. (If you have answered yes to any of these questions you may be denied entrance to the facility, so should contact the event organiser.) *

I confirm

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