ST AUSTELL ASC - Pre Training Health Screening
The purpose of this health screen form is to inform and make you aware of the risks involved partaking in swim training.

This form is to be completed by returning adult members or parents/guardians on behalf of members under the age of 18. If you wish to join us for swim training, you MUST complete this health screen (one for each swimmer).
Sign in to Google to save your progress. Learn more
Email *
Members/Swimmers First Name + Surname *
Swimmer's School (if applicable)
Parent's name (if swimmer under 18)
Contact telephone number in case of an emergency *
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 *
If Yes, please provide details
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) *
If yes, please provide details
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) *
If yes, please provide details
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? *
If yes, please provide details
Do you fully understand the information presented in the Covid-19 Return To Training briefing and accept the risks associated with entering the swim training environment in relation to the Covid-19 pandemic? *
If No, we will get in touch to see if we can help. Please provide a telephone number.
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy