Personal location form

To be completed by all competitors of Burnham Week 2020

Please complete this form for you and your crew members for Burnham Week 2020.
Skippers Name*
Contact Email*
Contact mobile number*
Date of race or start of event*

Day
Month
Year
Crew
First Name Last Name Age
Within the past 14 days have:*
- You or your crew had any symptoms of Coronavirus disease Covid 19 in the past 14 days
- You or your crew provided direct care for Covid 19 patients
- You or your crew worked in close proximity or in a closed environment with a Covid 19 patient
- You or your crew had any symptoms of Coronavirus disease Covid 19 in the past 14 days
- You or your crew provided direct care for Covid 19 patients
- You or your crew worked in close proximity or in a closed environment with a Covid 19 patient
Terms and Conditions*
- I understand
I understand that if I have answered yes on behalf of myself and my crew to any of the above questions that we may not enter the race or Regatta

First Name	Last Name	Age