Covid Tracking Nippers – Queenscliff Surf Life Saving Club

This field is hidden when viewing the form
Date
DD slash MM slash YYYY
Nipper Name*
First Last
Attending Parent Name*
First Last
Attending parent who will be in attendance with the Nipper.
Email*
Phone*
Age Group (s)*
- U6 - DOB 1st October 2014 to 30th September 2015
- U7 - DOB 1st October 2013 to 30th September 2014
- U8 - DOB 1st October 2012 to 30th September 2013
Consent*
I agree to COVID-19 Declaration
You or your family do not have any symptoms associated with COVID-19 (e.g. fever, cough, sore throat, shortness of breath, sneezing, runny nose, loss of sense of smell etc)

You do not have COVID -19 nor are you awaiting the result form being tested for COVID.

You have not been in contact with any known or suspected cases of COVID-19 in the past 14 days.

You have not returned or been in contact with anyone else who has returned form overseas in the past 14 days.
Do you have the Covid App?*
- Yes
- No
Date
MM slash DD slash YYYY

Quick Links