COVID-19 Questionnaire

To help prevent the spread of COVID-19 every NetballStar's parent/carer must complete, sign and submit this questionnaire before allowing their child to join a NetballStars session each week.

On receipt of your questionnaire, your coach may contact you to discuss your response and may ask you to refrain from the session.

PLEASE NOTE YOUR CHILD WILL NOT BE ABLE TO TRAIN IF THIS FORM IS NOT RECEIVED BY 9.00am ON THE MORNING OF THEIR SESSION

Participant Name

Date of Session

1. Does the particiant or anyone in your bubble have symptoms, now or in the past 14 days, of cough, fever, high temperature, sore throat, runny nose, breathlessness, flu like symptoms or loss of sense of taste or smell?

Yes

2. Has the participant or anyone in your bubble been diagnosed with confirmed or susected COVID-19 infection in the last 14 days?

Yes

3. Is the participant or anyone in your bubble a close contact of a person who has a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2 metres for more than 15 minutes accumulative in 1 day)?

Yes

4. Has the participant or anyone in your bubble been advised by a doctor to self-isolate at this time?

Yes

5. Please provide details of any other circumstances relating to COVID-19, not included in the above, which may need to be considered to allow your child to safely join the Session.

Name of Parent/Carer

Date form completed

I declare that the information I have provided is accurate and complete. I also agree as a parent/carer of the participant, that if the situaton changes after I have complete and submitted this form, or my answers to any of the above questions change, it is my responsibility to advise the coach immediately.

Thanks for submitting!