You must fill this COVID-19 Personal Screening out on the day your session is booked, before 3pm week days and 12PM on weekends or the booking will be cancelled


As parents / guardians you are filling this screening on behalf of the riders whom you a responsible for please read the below and answer carefully, this is not only to protect yourself but those around you on the sessions

Todays Date- this should be filled out on the day of the session ,not before

Are you/rider(s) currently diagnosed with or believe you may have COVID-19?yesno
Do you have a shielding letter/ advice for self isolation, If yes please do not attend the facilityyesno
Have you/rider(s) had any of these symptoms of COVID-19 in the past 14 days? yesno
High temperature (fever)? yesno
A new continuous cough? yesno
New unexplained shortness of breath? yesno
Sneezing or runny nose? yesno
A sore throat? /Loss of smell? yesno
Have you/rider(s) been in contact with a COVID-19 confirmed or suspect case in the previous 14 days?yesno
Provided direct care for COVID-19 patients in the past 14 days?yesno

Visited or stayed in a closed environment with anyone with COVID-19 in the past 14 days? This includes any business premises that have recently closedyesno

Traveled together with COVID-19 patient in any kind of conveyance in the past 14 days?yesno

Arrived in Northern Ireland from another country not on the ''green'' list in NI or ROI(not including UK and Ireland) in the last 14 days –this includes citizens traveling home?yesno

If you have answered YES to any of these questions above you should stay at home and inform your medical practitioner

I can confirm i have answered these questions truthfully to the best of my knowledge yesno

if any of the above changes 24hours before the booked session you must inform Lisburn BMX Club