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Home
Club
About
History
Honours
Governance
Committee
Constitution & Policies
Forms
Membership
Fees
Expression of Interest
Registration
News
Teams
MiniRoos
Juniors & Youth
Senior Womens
Senior Mens
Training Schedule
Media
Gallery
ARIS TV
Partners
Shop
Contact
Menu
Home
Club
About
History
Honours
Governance
Committee
Constitution & Policies
Forms
Membership
Fees
Expression of Interest
Registration
News
Teams
MiniRoos
Juniors & Youth
Senior Womens
Senior Mens
Training Schedule
Media
Gallery
ARIS TV
Partners
Shop
Contact
MEDICAL FORM
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Personal
Name
Surname
Email
Phone
DOB
Phone
Parents
Emergency
Team
FFA
Medicare
Ambulance Cover
Private Health
Do you suffer from any of the following? Tick if appropriate.
Health Selections
Asthma
Allergies (an Allergy alert form is required)
Migraines
Diabetes
Heart Problems
Epilepsy
Do you take any medication regularly or for emergency use?
Medication answer
Yes
No
Medication details
Do you wear contact lenses?
Contact Lenses answer
Yes
No
Have you suffered any major illness or injury in the last 12 months?
Illnesses answer
Yes
No
Illness details
Is there anything at all not covered in this document that the coaching staff should be aware of? (i.e. past history)
Other answer
Yes
No
Other details
Medical Consent of Treatment Acceptance
Parent/Guardian
As the parent/guardian of the player whose details appear on this form, or player (if 18 years or older whose details appear above) hereby consent to the player’s participation in training activities and competition matches under the direction of the staff appointed by the South Springvale FC. In the event of a medical emergency, I authorise any treatments or procedures that may be deemed necessary by a legally qualified medical practitioner.
SUBMIT