Return to Play COVID-19 Health Screening Juniors
The purpose of this screen is to inform and make you aware of the risks involved in returning to train
Terms & Conditions
Before returning to training please accurately complete and submit the form below:
Child's First Name *
Child's Surname *
Email Address *
Has your son/daughter had confirmed COVID-19 infection or any symptoms (listed below) in keeping with COVID-19 in the last two weeks - Fever, Persistent dry cough, loss of taste or smell? *
If ‘Yes’, please provide details:
If anyone answers yes to this question, NHS advice is, they should get a test to check if they have coronavirus as soon as possible. Stay at home and do not have visitors until they get their test results – only leave home to get a test.
Has your son/daughter had a known exposure to anyone with confirmed or suspected COVID-19 in the last two weeks? (e.g. close contact, household member) *
If ‘Yes’, please provide details:
Not allowed to train until you have self-isolated for 14 days.
Does your son/daughter have any underlying medical conditions? (Examples include: respiratory conditions including asthma; 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). *
If ‘Yes’, please provide details:
Does your son/daughter live with or will you knowingly come into close contact with someone who is currently ‘shielding’ or otherwise medically vulnerable if you return to the training environment? *
If ‘Yes’, please provide details:
This is an individual call, but awareness of risks and the appropriate precautions should be taken.
Sought Medical Advice *
If ‘Yes’, please provide details:
Able to train: *
Parents Name *
Parent Signature *
Date *
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