COVID-19 Form - Canbelto Women's Choir
Search our Site
Go to content
Main menu:
Home
Private Pages
Access
Notice Board
Current Repertoire
2018/19 Repertoire
2016/17 Repertoire
Prior Repertoire
Rehearsal Schedule
Calendar of Events 2019/20
Competitions/Trips 2019/20
Dublin Feis Ceoil - March 2020
Navan - May 2020
Contact Details
COVID-19 Form
You Tube Tracks
Diary Notes
Another Year of Wednesdays - 2018 - Maria's Diary
Recordings April 2016
Facebook Page
Performances
How Great Thou Art
Late Late Show
Sondheim NCH
Other
Mary's Poem
Trip Details Prior
Navan - May 2019
Dublin Feis Ceoil - April 2019
Derry - Oct 2018
Cork - April 2018
Rome - March 2018
Dublin Feis Ceoil - March 2018
Derry - Oct 2017
Navan - May 2017
New Ross - May 2017
Navan - May 2016
New Ross - May 2016
Wales - Nov 2016
Navan - May 2015
New Ross - May 2015
Tuscany - June 2015
Navan - May 2014
New Ross - May 2014
Sligo - Nov 2013
New Ross - May 2013
Navan - May 2013
Krakow - Sept 2012
New Ross - May 2012
Navan - May 2012
Lake Garda - April 2011
Cathy Remembered
How To...
Language Guide
Gallery
Video Links
Backstage Page
Our Logo
Recipe Corner
Ciara's Whiskey Marmalade
Ciara's Mince Pies
Órla's Flapjacks
Our Businesses
Notice Board
Current Repertoire
2018/19 Repertoire
2016/17 Repertoire
Prior Repertoire
Rehearsal Schedule
Calendar of Events 2019/20
Competitions/Trips 2019/20
Contact Details
COVID-19 Form
You Tube Tracks
Diary Notes
Recordings April 2016
Facebook Page
Performances
Other
COVID-19 Form
Private Pages > Access
COVID-19 QUESTIONNAIRE
Please complete this form
Each time you sign in for rehearsals or events we'll ask you to confirm that the answers you will provide now remain unchanged.
1. Your Name*
2. Your Email Address*
3. Rehearsal Date*
4. 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?*
Yes
No
5. Have you been diagnosed with/a close contact of a person diagnosed with a confirmed or suspected COVID-19 infection in the last 14 days?*
Yes
No
6. Have you been advised by a doctor that you should self-isolate at this time? *
Yes
No
7. Have you been advised by a doctor that you should cocoon at this time?*
Yes
No
8. Have you been advised by a doctor that you are in the very high risk group?*
Yes
No
9. Have you been outside the island of Ireland within 14 days of this rehearsal?*
Yes
No
10. If so, which country(s) have you visited?
11. I agree to wear a face covering, observe physical distancing and hand/respiratory hygiene practices before, during and after rehearsal. *
Yes
No
12. I confirm that should I begin to experience symptoms before/during/after rehearsals, I will inform the Covid Officer (Jimmy) immediately, and leave the rehearsal.*
Yes
No
Home
|
Private Pages
|
General Site Map
Back to content
|
Back to main menu
To use this website you must enable JavaScript