Limerick Swim Club Self Declaration

Limerick Swim Club

COVID-19 Return to Water Self Declaration Form (Athletes & Staff)
Swim Ireland accepts that it is not possible for any sport to eliminate the risk of the spread of the COVID-19 virus completely and are working with Limerick Swim Club to minimise risk; this concept must be fully understood and accepted by all Limerick Swim Club members who wish to return to the water and resume aquatic activities

The purpose of this document is to ensure everyone has considered the relevant risks and the required protocols and behaviours required to return to the water as safely as possible, and to confirm adherence to same.

Useful Links

International Travel Guideline -> Republic of Ireland / Northern Ireland

Close Contact Guidance -> Republic of Ireland / Northern Ireland
Name *

First Name Last Name
Date

Day Month Year
Date
1. I have reviewed the relevant protocols issued by Swim Ireland and agree to comply with them. *

Yes No
2. I acknowledge the risk of COVID-19 and I am returning to club training at my own risk. *

Yes No
3. I acknowledge that I play a vital role in minimising the spread of COVID-19, over and above the measures implemented by Swim Ireland. *

Yes No
4. I will not attend training if I have any COVID-19 symptoms, and if I test positive for COVID-19 I will advise my club’s Lead COVID-19 Officer. *

Yes No
5. If I am aware that I am a close contact of a COVID-19 case I will follow the guidance outlined by HSE/ NI direct and I will contact my club’s Lead COVID-19 Officer should I be required to self-isolate. *

Yes No
6. I agree to adhere to all COVID-19 notices at the facility, agree to adhere to all SI, club and the facility’s COVID-19 measures and agree to abide by any directions given by all club officers/coaches while on premises specific to COVID-19 health and safety measures. *

Yes No
7. I acknowledge that any measures are subject to change at short notice, where circumstances merit. *

Yes No
8. I agree to any changes in the terms and rules of my club membership where necessitated by COVID-19 requirements. *

Yes No
9. I understand that I may be subject to Swim Ireland disciplinary proceeding should I fail to comply with health and safety measures and/or directions from club officers in connection these protocols. *

Yes No
10. I agree to follow the most up to date guidance provided in respect of international travel. Republic of Ireland/ Northern Ireland *

Yes No
Please indicate your COVID-19 immunity status (over 18’s Republic of Ireland only) COVID-19 immunity is defined on www.gov.ie as fully vaccinated or recovered from COVID-19 within previous 6 months.
If you do not wish to disclose your immunity status, please contact your club’s Lead COVID-19 Officer.
Immunity Status *

I have COVID-19 immunity I do not have COVID-19 immunity I do not wish to disclose my COVID-19 immunity Status
Are you completing this form for an individual that is Under 18(U18)

Yes No
Name of Parent/Guardian

First Name Last Name
Signature

Clear
Please verify that you are human *
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform