CBSC Screening and Consent Form
Welcome back to the Club - we missed you
Just a bit of information we need to get you back on court soon !
Please pay attention to the health protocols in and around the club including taking your temperature, signing the register (to your right as you walk in) and sanitizing everything.
Email address *
What is your first name? *
What is your surname? *
What is your mobile number? *
Have you been in contact with anyone that has had COVID-19? *
If your answer is "yes" then you should consider not entering the club and playing, we would like to keep all our members safe!
To the best of your knowledge are you currently free of COVID-19? *
If your answer is "no" then you should probably consider not entering the club and playing, we would like to keep all our members safe !
Do you feel like you have any of the below symptoms ?
Should you check any of the boxes below please stay at home, practice self-isolation and contact medical professionals via one of these platforms : National hotline: 0800 029 999 or the Provincial hotline: 021 928 4102 or WhatsApp "Hi" to 0600 123 456
By ticking the "yes" box you hereby declare that you are fit, and in good health and can resume Training and/or Competition. *
Required
By ticking the "yes" box you hereby declare that at anytime if you suspect that you have COVID-19, have been in contact with someone who has COVID-19 or are experiencing any of the above mentioned symptoms you will stay home and will make the Camps Bay Squash Club Committee aware of your status if you have been at the club in the last 14 days. *
Required
By ticking the "yes" box you verify that you are familiar with and agree to abide by the return to play guidance outlined by Squash South Africa (found here http://www.squashsa.co.za/ and summarised below) : *
Phase 2: 20th of July 2020 Professional and Provincial players along with level 1 and 2 coaches are allowed to play (as defined and determined by SSA at http://www.squashsa.co.za/ ). Phase 3: 1st August 2020 Registered league players allowed to play. Phase 4: 15th August 2020 All members of the club are allowed to play.
Required
By ticking the "yes" box you verify that your identity as entered above is correct and confirm your acceptance of the terms and conditions below : *
I agree not to hold Squash South Africa, Organising Committee, the national, regional or local government, the provincial squash association, any sponsor, venue owner, club management, accommodation provider, transport operator, official, volunteer or any person and their agents assisting in the return to play after restrictions for COVID-19 have been lifted liable for any claims, injury or illness, or for any damage to my property or loss of my property which I may suffer directly or indirectly as a result of travelling to and from and participating in any events (from the time of arrival at the squash venue and/or official accommodation until the time of departure). I am aware that I should arrange my own insurance if I require.I participate voluntarily in squash and acknowledge that my health remains my sole responsibility.I agree to abide by guidelines of the club and Government and any rules and regulations promulgated by the club. I confirm that I am fit to participate. I agree to provide any COVID-19 related personal (full name, ID number, cell number etc.) or health related information to the club and medical personnel on request.I understand that COVID-19 tests may be requested at any time and agree to such a test if required and to provide the results to the club or other relevant parties.I also understand that club and/or its representatives have the right to suspend and/or expel me from the club if I act in contravention of its rules and regulations or if my continued participation may endanger the health or welfare of myself or any other person involved.By signing this document, I confirm that I am fit, in good health and can resume training and/or competition.I understand that I have the right to seek legal advice and have done so or have waived such right before signing this document.I am 18 years or older. I have read this document, and I am signing it freely. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms.
Required
A copy of your responses will be emailed to the address you provided.
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