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Covid-19 Questionnaire

This form needs to be filled out before the next climbing event

Your Name(Required)

Your Contact Number(Required)

Which climbing event are your planning to attend?(Required)

How many climbers including yourself, are going to the next event?

Please include yourself in this number

In order to climb with us at the next event, you need to answer NO to all of these three questions:

Name of first group member

1) Have you had any symptoms that might be associated with COVID 19 in the last 14 days

2) Have you been in contact with anyone that has displayed COVID 19 symptoms in the last 14 days

3) have you travelled outside the country in the last 14 days.

Name of second climber

1) Have you had any symptoms that might be associated with COVID 19 in the last 14 days

2) Have you been in contact with anyone that has displayed COVID 19 symptoms in the last 14 days

3) have you travelled outside the country in the last 14 days.

Name of third climber

1) Have you had any symptoms that might be associated with COVID 19 in the last 14 days

2) Have you been in contact with anyone that has displayed COVID 19 symptoms in the last 14 days

3) have you travelled outside the country in the last 14 days.

Name of fourth climber

1) Have you had any symptoms that might be associated with COVID 19 in the last 14 days

2) Have you been in contact with anyone that has displayed COVID 19 symptoms in the last 14 days

3) have you travelled outside the country in the last 14 days.

Name of fifth climber

1) Have you had any symptoms that might be associated with COVID 19 in the last 14 days

2) Have you been in contact with anyone that has displayed COVID 19 symptoms in the last 14 days

3) have you travelled outside the country in the last 14 days.

CAPTCHA

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