GAUTENG TOUCH

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Covid-19 Declaration and Indemnity Form

First Name

Last Name

Email

ID Number

Are you experiencing any of the below symptoms?

Coughing

Difficulty Breathing

Sore Throat

Fever

None of the above

Please let us know if you:

Have traveled to a high-risk country

Have been in contact with someone who has/had or is suspected to have Covid-19

Have been screened for Covid-19

Have been hospitalised in the last month

None of the above

Date

I confirm that the information given in this form is true

I accept all of the above risks and conditions and hereby indemnify and hold the South African Rugby Union, South African Touch Association, Provincial Unions, Provincial Association, Amateur / Community Clubs affiliated to Provincial Unions and All Associations affiliated to SA Rugby and their staff including the Compliance Officer blameless should I contract the disease at any touch rugby training or match venue.

Thanks for submitting!

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