junior medical form Medical Form Player Details Student * Student * Address * Parent/Guardian Details Parent/Guardian * Parent/Guardian * Email * Phone Phone Optional Medical Practitioner Phone Medicare No. Number on card Medical Questions Has your child had a tetanus booster in the last 12 months? * Yes No Comments (Tetanus) Asthma * Yes No Comments (Asthma) Other Respiratory Problems * Yes No Comments (Other Respiratory Problems) Drug Allergies * Yes No Comments (Drug Allergies) Other allergies * Yes No Comments (Other Allergies) Epilepsy * Yes No Comments (Epilepsy Sugar Diabetes * Yes No Comments (Sugar Diabetes) Heart Problems * Yes No Comments (Heart Problems) Blood Pressure Problems * Yes No Comments (Blood Pressure Problems) Other - Please List * Yes No Comments (Other - Please list) Recent Operations * Yes No Comments (Recent Operations) Injuries * Yes No Comments (Injuries) Learning Problems * Yes No Comments (Learning problems) Medication Additional Medical Problems Medical History Consent & Declaration I have read, understood, acknowledge and agree to the below declaration including the warning, exclusion of liability, release and indemnity. Insurance is in place that provides limited cover to you whilst you are performing or participating in any authorised or recognised SCBV activity. WARNING: Volleyball can be inherently dangerous. Serious accidents can and often do happen which may result in you being injured. I have voluntarily read and understood this warning and accept the inherent risks in Volleyball. I am aware of the types of activities included in the program and what they entail. I give consent for my child to participate in the program and agree to delegate my authority to the coaches involved. I further authorize the coaches in charge to obtain such medical attention as may be deemed necessary and I understand that I am responsible for the costs. I Agree * Yes No Media Consent Do you give Sunshine Coast Beach Volleyball permission to take photographs and / or videos of my child. Photographers or other professionals may be contracted to carry out the photoshoot and will be screened. Do you give Sunshine Coast Beach Volleyball full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity, or other purposes to help achieve the clubs aims. This might include (but is not limited to), the right to use them in printed form, websites, social media, press releases and funding applications. The photographs / videos will NOT be sold, used inappropriately, be given to any third party and will NOT be presented on non SCBV media. Media Consent * Yes No Parent/Guardian Signature * Clear Todays Date Subscribe to junior communications channel (Opt out at any time) reCAPTCHA If you are human, leave this field blank. SUBMIT
