Section 1 - Affected Person Details

Affected Person Name: *
Age:
Affected person's Club:
Contact Address:
Post Code:
Telephone/Mobile Number: *
Email Address: *

Section 2 - Additional Details

Home Country Athletics Federation: *

Please select the Country where this occurred.
Date symptoms started: *
Has the affected person been tested?: *

Section 3 - Declaration

I declare that:
  • Information provided is accurate.
  • I will follow the recommended Government guidance.

Contact Name: *
Email Address: *
Telephone / Mobile Number: