Participant Health Declaration

Parent name: *

Address: *

County *

Email address: *

Contact Number *

Camp venue *

Child name: *

Child name 2:

Child name 3:

1. Do you or your children have symptoms of cough, high temperature (38 degrees Celsius or higher), shortness of breath or sudden loss of sense of taste or smell now or in the past 14 days? *

Yes

No

2. Have you or your children been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *

Yes

No

3. Are you or your children a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2 metres for more than 15 minutes altogether in 1 day)? *

Yes

No

4. Have you or your children been advised by a doctor to self-isolate at this time? *

Yes

No

5. Have you or a member of your household travelled back to Ireland from abroad in the last 14 days. If yes, please state where. *

Yes

No

Country Visited *

Comments relating to COVID-19, not included in the above, which may need to be considered to allow your child/children safely participate in the camp.

Please review these questions daily. If your or your child/children’s situation changes after you complete and submit this form, please ensure you inform FAI representatives immediately. You will receive an email to confirm receipt of this declaration. Please check your spam folder in case the email is delivered there.