COVID 19 Welsh Judo Self Declaration Form

This form must be utilised to allow contact tracing and to ensure that you are free from Covid-19
symptoms and pose a limited risk to others. 

It is important that this form is completed on the day of the training session only.  It must me completed for the player attending the session (parent or guardian if under 18 years old) or the spectator and returned to the club for processing.

• I do not currently have symptoms of COVID-19 (new persistent dry cough, fever, loss
of taste or smell)
• I have not had a positive test for COVID-19 or onset of symptoms of COVID-19 in the
last 10 days. (Individuals who have completed their period of isolation (10 days) and
have no remaining symptoms (other than a dry cough or loss of taste or smell which
can last for some time) may return to normal activities)
• No member of my household has had symptoms of COVID-19 or has tested positive
for COVID-19 in the last 10 days
• I have not been contacted by a contact tracer from the Test, Trace and Protect
Programme and told to isolate in the last 10 days as a contact of someone with
confirmed COVID-19
• I have not returned from a country outside of the UK in the last 14 days, other than
those on the exempt list (https://gov.wales/exemptions-self-isolation-coronaviruscovid-19-html)
• I understand that the details provided may be stored in accordance with GDPR and if
requested, shared with the Test, Trace and Protect Programme for contact tracing
purposes.

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