Wicklow Archers Dargle Valley Training / League Registration & Return to Sport Covid19 Form
This is the Club Return to sport form - all information is confidential, and will be destroyed 3 months after gathering date. The Return to Sport form is required, as part of the Sport Ireland protocols for keeping everyone medically safe, while continuing sport, during the pandemic.

This form is required to be filled out by every member and visitor to any club training, competition, or other function, for each attendance. It should be filled out no more than 24 hours before attending, but not less than 4 hours before attending.

Only the Club Covid Officer and Competition Officer will have access to the information. Information will only be shared with the HSE after an official request for contact tracing. Information will not be shared with any other third party.

If you answer yes to any of the following questions, DO NOT attend the club. If you answer yes, to any question, click on the submit button, to inform the club, and contact your doctor by phone, if they are not already aware of your symptoms.

If you answer yes to question 7, you will be asked not to attend the club for 14 days. If you answer yes to any of the other questions, you will be asked to provide a letter of clearance from your doctor before returning to the club.

After filling in your name and date, in question 1, click on either yes or no for each question, and then click on the submit button, once you are content that all the information is accurate.
Email address *
Archery Ireland number *
1. Name *
Event Date *
MM
/
DD
/
YYYY
Time slot
Clear selection
2. Do you have currently, or have you had any of the following symptoms occur in the last 14 days, which are not part of a long term, known medical condition? Coughing, Fever, High Temperature, Sore Throat, Runny Nose, Breathlessness, Flu-like symptoms, Loss or taste or smell, or the sudden onset of any other symptoms. *
3. Have you been diagnosed with a confirmed or suspected case of Covid 19 in the last 14 days, or have you been advised to take a test for covid 19 by your doctor? *
4. Have you been in close contact (within 2m for 15 mins) with a person who has a confirmed or suspected case of covid 19 in the last 14 days? *
5. Have you been advised by a doctor or self isolate at the moment? *
6. Have you been contacted by the HSE contact tracers with regard to being in contact with a confirmed case within the last 14 days? *
7. Have you been outside the Republic of Ireland in the last 14 days? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Wicklow Archery. Report Abuse