Brigg and District Netball

Brigg and District Netball Club

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Medical Form

As with all sports, playing netball carries a small risk of injury. All sessions are run by qualified All England Netball Association coaches. Please complete the following, sign and return it to the Club as soon as possible.

If you have any queries please do not hesitate to ask any of the coaches.

Name of Player: ......................................................................................

Date of Birth: .....................................................................................

Name of Parent / Guardian: .....................................................................................

Address of Player: .....................................................................................

.....................................................................................

Postcode: .....................................................................................

Telephone No: .....................................................................................

Emergency Tel No: .....................................................................................

Family Doctor: ......................................................................................

Address : .....................................................................................

.....................................................................................

Any known medical conditions: (including current medication & allergies)

................................................................................................................................................................

Consent :

· I agree to my child taking part in the activities of the Brigg & District Netball Club.

· I confirm, to the best of my knowledge my child does not suffer from any other condition other than those listed above, and I will inform the Club of any changes to this if and when they arise.

· I consent to my child traveling by any form of public transport, minibus or motor vehicle driven by a Club Coach/Official or any other Parent attending, to any event in which the club is participating in.

· I authorise any Club Official accompanying the club, to consent to such medical treatment (including inoculations, blood transfusion or surgery) which in the opinion of a qualified medical practitioner may be necessary during any period of time when my child is with the Brigg & District Netball Club, and away from any direct parental control and direction.

Signed :.............................................................................Date:..............................................

Please print Name.........................................................................................................

(Parent / Guardian as named above)

A Local Club For Local Children