Personal location form

To be completed by all competitors of Burnham Week 2020

Personal location for Burnham Week 2020
Please complete this form for you and your crew members for Burnham Week 2020 For each race or for the 8 day regatta * = Required
Skippers Name*
Contact Email*
Contact mobile number*
Date of race or start of event*
Date dd/mm/yy
Crew one name*
Crew two name
Crew three name
Crew four name
Crew five name
Crew six name
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
I understand*
- 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 the race or Regatta