This form must be completed in order to attend a match at Oriel Park.

COVID19 COMPLIANCE

Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, flu like symptoms or loss or change to your sense of smell or taste now or in the past 14 days? *
Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *
Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2 metres for more than 15minutes altogether in 1 day)? *
Have you been advised by a doctor to self-isolate at this time? *
Have you been advised by a doctor to cocoon at this time? *

CONTACT PREFERENCES

Preferred contact method ? *