GFA Covid-19 Screening Form

GFA COVID-19 DAILY SCREENING FORM

*Full Name of SAGF Member

*Temperature

*SAGF Member Number

*Today's Date

*Time of Training

*Phone Number

*Street Address

Mokopane
Limpopo
0601

*Do you have any of the following symptoms?:

*Have you been in contact with anyone in the last 14 days who is experiencing these symptoms?

*Do you or anyone you live with, have any of these symptoms?:

*Description of transport:
Mom / Dad / Taxi / Caretaker / etc.

I hereby consent to today's gymnastics lesson for this gymnast. I confirm his/her temperature reading today is as recorded and he/she nor anyone they live with, have any symptoms. I confirm that the above information is correct, and to the best of my knowledge.

Signature

This form will be used for tracking purposes only, should anyone test positive for Covid-19. We have your best interest at heart, and your care is our top priority.

This form will be distributed to SAGF district offices on a monthly basis. Forms will be recorded and will not be shared publicly.

Please note that athletes/officials will have to complete the form for each training session. Unfortunately if the athlete/official does not complete the form, they will not be able train for that session on the day.

I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. I understand that due to the frequency of visits of other gymnasts, the characteristics of the virus, and the characteristics of gymnastics activities, that I have an elevated risk of contracting the virus simply by being at the gymnastics venue.

High risk patients relating to the severity of COVID-19 are persons over the age of 60 and persons who have pre-existing medical conditions such as: asthma, chronic lung conditions, hypertension, autoimmune disease, organ transplants, cancer, immunocompromised, obesity (BMI over 40) and liver or kidney disease conditions.

I confirm I, nor my minor fall into any of these high-risk categories. I am aware of the risks involved with the spread of COVID-19 and the risks it may hold to my health and the health of others I come in contact with. I accept those risks and hereby indemnify and hold the gymnastics club and his/her staff blameless should I contract the disease at the venue of the gymnastics club or from the gymnastics club staff members.

I will abide by all the regulations and rules for participation in gymnastics activities as laid out in the SAGF COVID-19 policy. I have read and understood these regulations and rules for participation in gymnastics activities as laid out in the SAGF COVID-19 policy and confirm I will comply thereto and prepare accordingly.