Monday 17 January, 5:30pm to 7:00pm
Chestnut Grove Academy
Do you provide consent for photos and videos to be taken for marketing purposes?
Do you have any disabilities or additional needs?
Do you take any medication or have any allergies or medical conditions?
Will you be collected by a parent / guardian?
We have put in place a range of measures to ensure we can restart face-to-face activities. With the ever-changing situation with Covid-19, it is essential we understand the recent health of all our participants.
Each participant should self-screen prior to arrival at a session to ensure they do not have any of the following symptoms (confirmed by a parent for those aged under 18), as these are potential indicators of Covid-19 infection.
Please complete the following based on the participant's current and recent health over the past 14 days.
A high temperature (above 37.8 C)?
A new continuous cough?
Shortness of Breath?
A sore throat?
Loss of or change in normal sense of taste or smell?
Feeling generally unwell?
Been in close contact with / living with a suspected or confirmed case of Covid-19 in
the previous two weeks?
I declare that all the information provided on this form is correct. If there are any changes that lead to new or existing medical conditions, or Covid-19 symptoms, I will notify Fulham FC Foundation immediately.