Health Questionnaire Form for Castletroy Hockey Club
This form is to be filled out for every player, volunteer and coach within Castletroy Hockey Club. It should be filled out before your first training session.
If you are a parent, please complete this form for every child that you have playing within the club. It only needs to be completed once at the start of the season. In the case of filling the form out for a child, the term "You" or "Your" refers to your child's name.
Do you believe you may currently have COVID 19?
Have you had any of the following symptoms of COVID 19 in the last 14 days?
A High Temperature (i.e over 37.5 degrees celsius)
A new continous cough
A New unexplained shortness of breath
A Loss of sense of smell, or taste or distortion of taste
None of the above
If you selected any of the symptoms above you should stay at home and contact your GP for further advice.
If you selected NONE OF THE ABOVE, your child may train and play with their team.
Has anyone in your household returned from a non green travel area in the last 14 days?
If you selected YES to the above question, you need to stay at home and self quarantine for 14 days from the date of return to Ireland.
By submitting this form, you confirm that the details above are true to the best of your knowledge and that you have read the COVID 19 Guidelines sent to you by Castletroy Hockey Club (viewable at:
). You agree to inform the club should you develop any symptoms of COVID-19 and will not participate in club activity until you have medical clearance to do so.
I agree to the above terms and conditions
This Form should be completed once per person. It will be the responsibility of the player / parent / guardian to notify us if your health situation changes.
Data Protection Notice
The personal data you provide on the Health Questionnaire is being collected in order to help prevent the spread of COVID-19. Your personal data is being processed in accordance with Article 9(2)(i) of the General Data Protection Regulation, and Section 53 of the Data Protection Act 2018. The information you provide on this form will not be used for any other purpose, and will be strictly confidential. Castletroy Hockey Club, Munster Hockey & Hockey Ireland are Joint Data Controllers for the information on this form. Your information will be stored on on the Google Forms Platform. This form will be accessible only by the designated COVID Supervisors in your Club. The personal data you provide on the Health Questionnaire will be retained for the 2020-21 Hockey Season.
If you have any questions on this form, you can contact us at
If you wish to raise a concern or report a breach in relation to your personal data, you can do so via the applicable webforms on the Data Protection Commission’s website at
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