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Covid 19 Health Questionnaire

* Indicates required field

Activity *

Zumba Tennis Kickboxing Saturday Club Dance Football Causey Camp

Name of Member / Parent Guardian *

In the last 14 days have you or your family members had *

New flu like symptoms including (shortness of breath, difficulty breathing, runny nose, sore throat, loss of taste or smell) New temperature/fever above 38c of unknown cause New Chest infection Shortness of breath or cough Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? Have you had close contact with someone who has been diagnosed with Covid 19? None of the above

If you have any symptoms listed above, you will not be allowed to participate in the activity *

Yes

By submitting you are agreeing to adhere to the Special Hands Group Covid 19 Guidelines

Comment / Further Information *

Submit

Membership Form

Please download and complete the membership form and return it to specialhandsgroup@gmail.com
The form must be completed and returned to an Officer or Trustee of Special Hands Activity Group

special_hands_policy_and_code_of_conduct_final_may2018.docx
File Size:	76 kb
File Type:	docx

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special_hands_membership_form_final_may2018.doc
File Size:	113 kb
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Home
About Us
- About Us
- Donations
- AGM
- Governance
Activities Schedule
Contact
- Forms

Covid 19 Health Questionnaire​

Membership Form

Covid 19 Health Questionnaire