Shirley Swimming Pool: Covid-19 Self Declaration

Please complete and signed to resume swimming activities.

Adults Name________________________________________________________________

Childs Name_______________________________________________________________

Membership number______________________________________________________

Sign only if you can confirm the following: 

  • You have not been in contact with anyone who has confirmed case of Covid-19 and/ or has CV Symptoms E.g. persistent cough, High fever, Breathlessness, in the last 14 days. 
  • You are in a healthy state and will be able to swim otherwise. 

Sign_______________________________ Date________________________________

Please follow link below for a print out copy

Click here for a printable form