Covid 19 Form

Covid 19 Report Form 2020
Surname*
Forenames*
Age
Club
Address
Post Code
Telephone*
Email
Email*
Further Treatment or condition?
Date of positive test
Have you attended/ taken part in a UKA event/club session etc within 48hrs of this test?
- Yes
- No
If yes, please provide details, date and location
Untitled
I understand that I must not attend club or events at this time*
- Acknowledged
Home Territory
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