COVID19 Declaration Form

Name *

First

Last

Date of Birth *

Email *

Contact Number *

COVID19 Declaration *

I have not displayed symptoms of COVID19 in the last 14 days
I agree that it is not unreasonable nor would it be considered an act of discrimination to exclude someone on the grounds of COVID19 transmission at this time
I agree to forfeit my participation if my guide / instructor believes I am showing symptoms of COVID19 (for example a continuous cough)
I acknowledge and accept that participation in a given activity may be exposing me to an increased risk of infection, relative to non-participation

I have NOT been in a household / had contact through work or socially, with someone who has displayed symptoms in the last 14 days *

Signed *

Date *

COVID19 DECLARATION FORM