Covid-19 Form

Your Details

Club/ Team Name (required)

First Name (required)

Surname (required)

Mobile No. (required)

Main Contact Email (required)

Date/ Time of Booking (required)

The Questionnaire

Have any members of your club/team travelled abroad in the last 14 days?(required)
YesNo

If Yes ^ Please state where!

Have any members of your club/team displayed any symptoms of Covid-19 in the last 14 days, namely fever, high temperature, persistent coughing, breathing difficulties / shortness of breath, and. or loss of taste or smell? (required)
YesNo

If yes, which symptom(s) have they displayed!

Have any members of your club/team displayed any symptoms of Covid-19 in the last 14 days, namely fever, high temperature, persistent coughing, breathing difficulties / shortness of breath, and. or loss of taste or smell? (required)
YesNo

If yes, please provide details!

If you answered Yes to any of the foregoing questions, have they consulted a Doctor or other medical practitioner? (required)
YesNo

Has any member of your club/team been advised by a doctor to self-isolate at this time? (required)
YesNo

Have temperature checks been completed for all members of your club / team before visiting the site? (required)YesNo

Do you understand that it is your responsibility as a club/team to keep an accurate record of the names, phones numbers, date and time of every player who plays/trains at Maccabi London? (required)
YesNo

NOTE:

When on site, please ensure your club/team follow our direction in respect of Covid-19, to include our on-site standard procedures regarding infection control (e.g. hand washing/hand sanitising, general coughing/sneezing etiquette, etc.).

Information supplied in this questionnaire may be shared with any of our employees that you come into contact with and/or with the relevant authorities for contact tracing purposes.

Maccabi London reserves the right to refuse admission to its facilities if they feel the questionnaire has been answered falsely or if a user is exhibiting any of the signs of COVID-19 infection.

If this is the case, the booking will be cancelled and a refund will be made, with a £25 administration deduction.

I confirm that on behalf of my team the above information is accurate to the best of my knowledge:
Yes

I agree to the Maccabi London Terms & Conditions
Yes

I agree to the Site Operating Policy
Yes