Ashbourne United

COVID-19 Self Declaration Form

Form must be filled out on the actual day of and 2 hours before every training or match activities, failure  to do so will mean you will not be able to enter or take part in any activities within Ashbourne United.

Have you been advised by a doctor to cocoon at this time?

Have you been advised by a doctor to cocoon at this time?

Have you travelled to any country outside of the approved Irish Governments COVID-19 Green List in the last 14 days?

Full Name 

Team

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Contact Phone Number

Date of Training or Match

Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days?

Are you 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)?

Have you been advised by a doctor to self-isolate at this time?

Do you have symptoms of: high temperature (fever), cough, shortness of breath or breathing difficulties, loss of taste or sense of smell, now or in the last 14 days?

By hitting submit you are confirming you have answered no to all the questions above.

If for any reason you have answered yes to any of the questions please contact Ashbourne United's COVID Officer - Robbie Giles 087 280 8080.

Players and Coaches must inform the club if there are any other circumstances relating to COVID-19, not included in the form, which may need to be disclosed to allow their safe return to training or matches.

When you hit submit please wait for the confirmation page

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