To be completed within 48 hours of the event only
Email address *
I confirm that within the last 14 days I & the competitor(s) (or someone I live with) have not been unwell with any of the
following symptoms:

• A high temperature
• A new, continuous cough
• A loss of, or change to, my sense of smell or taste

If I or competitor (or someone I live with) have demonstrated any of the above symptoms, I will follow NHS and PHE
guidance on self-isolation and not attend the event.

Since January 2020, if you have tested positive for Covid-19:

• If you were hospitalised due to Covid-19, you should undergo a form of health screening prior to
taking part in a triathlon or multisport. This screening is best led by a doctor with specialist
training in sports medicine. However other doctors may feel competent to make decisions on your
fitness to compete and to decide any appropriate investigations that might be required.

• If you were not hospitalised due to Covid-19, but self-isolated having tested positive or shown
symptoms at any time, you are also recommended to undergo a form of screening.

• If you have felt entirely well during the pandemic, you are not routinely recommended to
undergo health screening, but it is something to be considered as part of your normal health
monitoring for the health-conscious competitor.

Your GP should be able to guide you on what level of screening you may require, and who is the best
person to assist you in the process.
I also confirm that in light of recent restrictions on movement the young person is suitably fit to take part in the event. TICK CHECK BOX to confirm that the information submitted is accurate.The information in this document is held subject to the event organisers’ privacy policy and will be shared with NHS Testand Trace upon request. *
Date of form completion *
Name of Competitor (Fname, Lname) *
Name of Second Competitor (Fname, Lname)
Name of Third Competitor (Fname, Lname)
Contact Telphone Number *
Spectators names (Please list all attending) *
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