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Medical Form
Updated medical form
Player Name:
Age:
Date of birth:
Parent/Guardian name:
Contact number:
E-mail:
Emergency contact name:
Emergency contact number:
Relationship to player:
Medical conditions:
Past/Current Injuries
In the event the named player is injured whilst training or playing football, I hereby give consent for my child to receive medical attention.
Yes
No
I agree for pictures and videos to be used as promotional material on the website and social media.
Yes
(Covid-19 Waiver) - I agree to social distancing, cleaning and any additional measures deemed necessary & accept responsibility for my child attending.
YES
Signed:
Todays Date:
Time signed:
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