Covid-19 Pre-Booking Form

Self Declaration Form

This Self Declaration Form below must be completed for each booking.
This is a mandatory requirement for Contact Tracing.
On Completion, you will receive an e-mail with a link to proceed with your booking.

LIMITED ACCESS TO THE POOL DURING SWIMMING LESSONS FROM 4PM – 8PM MONDAY TO FRIDAY

Name *

First

Last

Email *

Email:

Phone

Question 1: Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2 meters for more than 15 minutes accumulative in 1 day) *

Question 2: Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, or flu like symptoms now or in the past 14 Days. *

Question 3: Have you been advised by a doctor to cocoon at this time. *

Question 4: Have you been advised by a doctor to self isolate at this time? *

Question 5: Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days. *

Question 6: Do you have any other circumstances relating to COVID-19, not included in the above, which may be applicable at this time . If your situation changes after submission of this form please contact management. *

Comment

Cavan Leisure Centre

Phone: 049 436 2888

Self Declaration Form

LIMITED ACCESS TO THE POOL DURING SWIMMING LESSONS FROM 4PM – 8PM MONDAY TO FRIDAY