Southern Gauteng schools hockey COVID SCREENING
All of Southern Gauteng schools coaches, players, managers, umpires or any other related person entering the school/ venue for sports purposes needs to complete this form upon entry
If you do not not complete the form you are not allowed to enter the venue by regulation.
NB: No spectators are allowed.
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Player name and surname:
Date of practice/ game
Reason for entering venue:
Management (Coach/manager etc)
Technical staff (V/A, tech table etc)
Assumption (EG affiliated)
Brescia House School
Crawford College Lonehill
Crawford College Sandton
Crawford Int. Ruimsig Maragon
De La Salle Holy Cross College
Edenvale High school
Fourways High School
Glenvista High School
Holy Rosary school
HTS Carel de Wet
Hyde Park High
Jeppe High School for Girls
Marist Brothers Linmeyer/ Marian Col
Midrand High School
Mondeor High School
Northcliff High School
Pinnacle College (Summit)
Queens High School
Rand Girls High
Rand Park High School
Roedean School SA
Roosevelt High School
Sir John Adamson
St Andrew's School for Girls
St Barnabas College
St Catherine's Convent
St Martins School
St Mary's Waverley school
St Peter's College
Suiderlig High School
The King's College Bryanston
The King's School West Rand
Trinityhouse Little Falls
Trinityhouse Randpark Ridge
Wendywood High School
If you answer yes to any of these symptoms, please refrain from entering the venue
Attending a session at the venue whilst having any of the symptoms puts management, coaching staff and fellow players at risk.
Please select all relevant options:
Excessive Tiredness of unknown origin
Fever or Temperature above 37.5 degrees
Persistent Shortness of Breath
Persistent Joint or Body Pain (Not Sports related)
Severe headache of unknown origin
Sore Throat and/or Swollen Tonsils
Persistent Diarrhea for more than 2 days
Loss of taste or smell
None of the above
I knowingly and willingly consent to attend Hockey training as permitted under current Alert Level Regulations at all venues opened by the GDE.
I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious.
I understand that due to the frequency of visits of other hockey players, the characteristics of the virus, and the characteristics of hockey activities, that I have an elevated risk of contracting the virus simply by being at the hockey venue.
High risk patients relating to the severity of COVID-19 are persons over the age of 60 and persons who have pre-existing medical conditions such as: asthma, chronic lung conditions, hypertension, autoimmune disease, organ transplants, cancer, immunocompromised, obesity (BMI over 40) and liver or kidney disease conditions.
I acknowledge that if I have tested positive for COVID-19, a letter from a doctor confirming a subsequent negative test must be submitted my school as well as Southern Gauteng schools management prior to being permitted back on to the field.
I understand that should I have a pre-existing condition which increases my risk that I need to declare it.
I am aware of the risks involved with the spread of COVID-19 and the risks it may hold to my health and the health of others I come in contact with.
I accept those risks and hereby indemnify and hold the SASHOC, SOUTHERN GAUTENG SCHOOLS and all SAHA/SGHA certified venues opened and their staff blameless should I contract the disease at the hockey venue or from the venue staff members.
I will abide by all the regulations and rules for participation in hockey as laid out in the COVID-19 SA Hockey Operational Guidelines, Return to Play Framework and the venues I am training at.
I have read and understood the terms of this indemnity as laid out and confirm I will comply thereto and prepare accordingly.
By checking this box, you are digitally and legally agreeing to the declarations as stated above *
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