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Track & Trace Registration
17th / 18th July 2021

The below form is required to be filled in to confirm your NHS Track & Trace registration for Staveley Miners Welfare Junior Tournament 2021.

This form must be filled in by all visitors for the required day of the tournament.

By completing this form you confirm that you or anyone within the household has not experienced any of the below symptoms within the last 10 days:


Loss of taste and/or smell?

Persistent cough?

Shortness of breath or difficulty breathing?

Aching Joints?

Head ache or eye ache (especially when looking up)?
High Temperature?
Do you believe you have recently come into contact with
someone displaying these symptoms?

By signing this form I also confirm I comfortable with the clubs COVID-19 planning arrangements for the Tournament.

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Thanks for submitting!