DDR21 COVID-19 Self-Assessment Health Declaration
You are at bit.ly/DDR21HealthDeclaration for the Desborough Dashes Regatta 2021

TO ALL Competitors, Coaches, external agencies and any Spectators - please complete ONE FORM PER CLUB

TO ALL Volunteers - please complete ONE FORM PER PERSON

* You MUST enter your details below before collecting any race numbers, or (for volunteers) any equipment for use at the regatta.

* Mandatory fields are marked with a red asterisk.
* Your date and time are logged automatically.

Information will be stored securely for a maximum of 21 days after the competition and only used in the event that a positive case comes to our attention. This is a necessary measure to comply with Government guidance and ensure the safety of our competitors and volunteers which is why full compliance is essential.

Your club, school or organisation (Your Club) has designated a COVID-19 officer who is responsible for ensuring that all those present from Your Club adhere to the strict measures required by the Government and by the regatta at all times.

The competition has appointed a COVID-19 Officer, Christopher Edgley, who is responsible for the advising the regatta organisers. If you have any concerns about this please email chris@weybridgerowing.org.uk 
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YOUR FULL NAME
Your first name(s) *
Your surname *
Your contact number - ideally a mobile phone number, please *
Your contact email address *
YOUR CLUB
YOUR BOATING & LANDING LOCATION *
Listed in order from the Start (downstream) to beyond the Finish (upstream)
HEALTH DECLARATION
By submitting this form, you are declaring that all for whom you are signing this declaration:
1. Have NOT been in close contact with anyone in your household or 'social bubble' who has tested positive for COVID-19 in the past 14 days;
2. Are NOT experiencing any symptoms of coronavirus - high temperature, new continuous cough, a loss or change to your usual sense of smell or taste;
3. Are NOT generally unwell - increased heart rate, raised temperature, cough, sore throat, shortness of breath, nasal congestion, headache, fatigue, loss of appetite, nausea and vomiting.
I hereby accept the above health declaration and contact details provided to be accurate *
Required
Further Information
Additional information about COVID-19, can be found at nhs.uk/conditions/coronavirus-covid-19/

For information on the organising club's data protection policy, please visit bit.ly/WEYPrivacyPolicy
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