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Hockey Ireland Covid 19 Return to Play Form
This form must be completed and submitted no more than two hours prior to every training session.
*
Indicates required field
Date:
*
Team/Section:
*
Name:
*
1. Do you believe you may currently have COVID-19?
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Yes
No
2. Have you had any of the following symptoms of COVID-19 in the past 14 days? • High temperature (over 37.5°C)
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Yes
No
• Loss of sense of smell and/or taste
*
Yes
No
• New continuous cough
*
Yes
No
• New unexplained shortness of breath
*
Yes
No
If you have answered YES to any of these questions above, you should stay at home and contact your GP by phone for further advice. If you have answered NO to all the above questions, you may train or play with your team on the date specified above.
Please sign this form to confirm that the details above are true to the best of your knowledge and confirm that you understand the risks involved in participation, are participating on a voluntary basis and that you may opt-out at any time.
Declaration: I agree to inform the club CVO should I develop any symptoms of COVID-19 and will not participate in club activity until I have medical clearance to do so.
Signed:
*
*(For underage players, this document should be signed by a Parent or Guardian)
Please provide your contact details in the event contact tracing is required:
Phone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Please follow all Hockey Ireland Return to Play Protocol when travelling to and from the ground and when partaking in training sessions. A copy of these can be found here:
https://www.hockey.ie/hockeyireland?content_page=COVID-19
Submit
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