Swindon Town Academy - Visitor COVID Screening - U18, Newport. 17.10.20

Please complete the below form as accurately as possible in order to gain access to the venue.

This form will need to be completed by a responsible adult over the age of 18 - please complete this for your child if they are under the age of 18.

Due to the latest restrictions, we are unable to allow spectators at the venue until further notice.

Full name of *PLAYER/STAFF MEMBER* attending the fixture: *
Team: *
Fixture attending: *
Full name of person completing this form: *
Contact number of person completing this form: *
Has the *PLAYER OR STAFF MEMBER* been in close contact with anyone who has shown symptoms, or tested positive for COVID 19 within the last 14 days? *
In the last 14 days, has the *PLAYER OR STAFF MEMBER* been experiencing a high temperature, above 37.8 degrees? *
In the last 14 days, has the *PLAYER OR STAFF MEMBER* member developed a new, continuous cough? *
In the last 14 days, has the *PLAYER OR STAFF MEMBER* experienced a loss or change to their sense of taste or smell? *
I can confirm that I have completed this form truthfully. If there is any change to the answers of the above COVID questions, I agree that the *PLAYER OR STAFF MEMBER* will not attend. *
Signature: (full name of person completing this form) *
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