Members Checking In Form
Checking in form for all members attending any site, for any reason
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Email *
Name *
What date are you signing in for *
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Session Type *
Which Venue are you attending *
Required
Activity *
Required
Dry Bait Orders can be paid in advance and collected from the Inner Cabin at Beechhill. PayPal account - payments@nicca.org.uk
COVID 19 Declaration - Have you been in close contact (<2m for 15minutes or more) with anyone who is confirmed to have had COVID-19 virus in the last 14 days? *
Required
COVID 19 Declaration - Have you been in close contact (<2m for 15minutes or more) with anyone who is suspected of having COVID-19 virus in the last 14 days? *
Required
COVID 19 Declaration - Do you live in the same household with someone who has symptoms of COVID-19 who has been in isolation within the last 14 days? *
Required
COVID 19 Declaration - Have you been advised by a doctor to self-isolate at this time? *
Required
COVID 19 Declaration - Are you suffering now, or have you suffered any the following symptoms in the past 14 days? Cough, Breathing difficulties, Fever/ High temperature, Sore Throat, Runny Nose, Flu Like Symptoms, Rash, Loss Of Smell/Taste *
Required
COVID 19 Declaration - Have you returned to Northern Ireland from another country within the last 14 days? *
Required
COVID 19 Declaration - I confirm that I have not travelled from another country in the past 14 days, that I have not been in close contact with anyone who has been outside of the country in the past 14 days, that I have not been in close contact with anyone who is in self-isolation in relation to COVID-19 in the past 14 days, that I am not suffering from any COVID-19 symptoms nor do I believe for any reason that I have contracted the virus. I commit to advising management and excluding myself if this situation changes, (i.e. if at a point in the future, I would answer “yes” to any of the above questions). *
A copy of your responses will be emailed to the address you provided.
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