St Colm's Basketball Club COVID-19 "RETURN TO PLAY" Health Declaration Form
Parents must complete the form below for children U18 years. Please complete separately for each child.

N.B. Players will not be allowed return to play if this form isn’t completed in full.

Please contact Marguerita Sweeney - our club Covid Officer with any queries, stcolmscovidofficer@gmail.com
Player's Name: *
Parent's Name: *
Today's date: *
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Team: *
Required
Have you/your child had symptoms of persistent cough, high temperature (38 degrees Celsius or higher), shortness of breath or sudden loss of sense of taste or smell in the last 14 days? *
Required
Have you/your child been diagnosed with confirmed or suspected Covid-19 infection in the last 14 days? *
Required
Have you/your child been in close contact with a person who is a confirmed or suspected case of Covid-19 in the past 14 days? *
Required
Have you/your child been advised by a doctor to self-isolate at this time? *
Required
Have you or a member of your household travelled back to Ireland from abroad in the last 14 days? *
Required
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