Requin Covid Screening Form/ Register
To be submitted digitally on Friday after 18h00 the evening before the event
Name
*
First Name
Last Name
E-mail
*
example@example.com
Cell Number
*
Please enter a valid phone number.
Format: 0000000000.
ID or Passport number
*
SA Number
Competition Date
*
-
Day
-
Month
Year
Date
Competition Venue
*
Dry cough
*
Yes
No
Chills
*
Yes
No
Sore throat
*
Yes
No
Shortness of breath
*
Yes
No
Diarrhea
*
Yes
No
Myalgia/Body pains
*
Yes
No
New-onset loss of taste & smell
*
Yes
No
Have you been in contact with a confirmed/suspected Covid-19 case within the past 14 days?
*
Yes
No
I declare that I have honestly answered all questions and personal details are true and correct
*
Yes
Temperature reading
Please verify that you are human
*
Submit Form
Should be Empty: