COVID-19 SCREENING AND DECLARATION FORM

Complete the form below to re-active your membership

COVID-19 Declaration Form

  • the COVID-19 virus has a long incubation period during and carriers of the virus may not show symptoms, yet still be highly contagious;
  • having one or more of the comorbidities increase my susceptibility to COVID-19; and
  • sport activities, such as squash, take place with players being in close proximity of each other, which potentially, increase my expose them to COVID-19.

I therefore understand that due to the frequency of visits of other members and or players, the characteristics of the COVID-19 virus and the nature of sport, that I have an increased risk of contracting COVID-19 by simply being at the sports facility.

I have been made aware of the rules and procedures of Uitsig Squash Club (USC), pertaining to access, use and restrictions of the USC’s facilities that are applicable during the COVID-19 period. I also understand the USC Return to Club in-phasing directions and agree to comply therewith.

I also understand that the club reserves the right to suspend my membership indefinitely should I not adhere to the COVID-19 rules and procedures.

I understand that should I exhibit any of the below symptoms not access the Club. If at the Club I declare I will vacate the Club and inform the nominated Covid-19 Compliance Officer. I shall not return to the Club until such time I no longer exhibit such symptoms and/or the prerequisite period of 14 days has expired or I am cleared by a medical practitioner, whichever applies as directed by law and/or the Club’s rules and directives.

Symptoms

  • Are you having difficulty breathing?
  • Do you have a dry cough?
  • Do you have a fever?
  • Are you experiencing fatigue/tiredness?
  • Do you have diarrhoea?
  • Do you have a sore throat?
  • Are you experiencing body ache?
  • Do you have headaches?
  • Have you travelled recently in the past 14-days?
  • Have you had direct contact with a COVID-19 positive person?
  • Body temperature when screened exceeding 37.5 °C?