Basic Medical and Injury Form

We’re excited to have your child join our Holiday Sports Clinic! Please fill out the short form below—it won’t take more than a minute.

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Question 1 of 22

Participant details:

Child’s full name

Paragraph answer

Question 2 of 22

Participant details:

Date of birth

Paragraph answer

Question 3 of 22

Participant details:

School and year level

Paragraph answer

Question 4 of 22

Participant details:

Sport or sports they mainly play

Paragraph answer

Question 5 of 22

Parent or guardian details:

Parent or guardian name

Paragraph answer

Question 6 of 22

Parent or guardian details:

Mobile number

Paragraph answer

Question 7 of 22

Parent or guardian details:

Email address

Paragraph answer

Question 8 of 22

Emergency contact (if different from above):

Name

Paragraph answer

Question 9 of 22

Emergency contact (if different from above):

Relationship to child

Paragraph answer

Question 10 of 22

Emergency contact (if different from above):

Mobile number

Paragraph answer

Question 11 of 22

Medical information:

1. Does your child have any current or previous injuries we should know about (for example knee pain, ankle sprains, back issues, Osgood, Sever’s, shoulder problems)?

A

No

B

Yes, please give details on the next page

Question 12 of 22

Injury Information – If You Answered “Yes” in the Previous Question; N/A if "No"

Paragraph answer

Question 13 of 22

Medical information:

2. Does your child have any medical conditions (for example asthma, diabetes, epilepsy, heart condition, concussion history, developmental or behavioural diagnosis)?

A

No

B

Yes, please give details on the next page

Question 14 of 22

Medical Condition – If You Answered “Yes” in the Previous Question; N/A if "No"

Paragraph answer

Question 15 of 22

Medical information:

3. Allergies (including food, medication, insect bites, grass, tape etc)

A

No

B

Yes, please give details on the next page

Question 16 of 22

Allergy Details – If You Answered “Yes” in the Previous Question; N/A if "No"

Paragraph answer

Question 17 of 22

Medical information:

4. Is your child currently taking any medication?

A

No

B

Yes, name of medication, dose and timing on the next page

Question 18 of 22

Medication Information – For “Yes” Answers in the Previous Question; N/A if "No"

Paragraph answer

Question 19 of 22

Asthma and anaphylaxis management:

5.1 Does your child have an asthma action plan?

A

No

B

Yes (please bring any puffers and spacers to each session)

Question 20 of 22

Asthma and anaphylaxis management:

5.2 Does your child have an anaphylaxis plan or require an epi pen?

A

No

B

Yes (please bring any required medication to each session)

Question 21 of 22

Medical information:

6. Is there anything else we should know to help support your child safely and confidently at training (for example recent illness, concerns about fitness, anxiety in groups, learning or concentration difficulties)?

Please provide details:

Paragraph answer

Question 22 of 22

Parent or guardian declaration – medical:

I hereby confirm that the information above is correct to the best of my knowledge. I acknowledge my responsibility to update Sunshine Coast Sports Training with any changes.

A

I agree

Confirm and Submit

Name

Email

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Basic Medical and Injury Form

Click the button below to start.

Participant details: Child’s full name

Participant details: Date of birth

Participant details: School and year level

Participant details: Sport or sports they mainly play

Parent or guardian details: Parent or guardian name

Parent or guardian details: Mobile number

Parent or guardian details: Email address

Emergency contact (if different from above): Name

Emergency contact (if different from above): Relationship to child

Emergency contact (if different from above): Mobile number

Medical information: 1. Does your child have any current or previous injuries we should know about (for example knee pain, ankle sprains, back issues, Osgood, Sever’s, shoulder problems)?

Injury Information – If You Answered “Yes” in the Previous Question; N/A if "No"

Medical information: 2. Does your child have any medical conditions (for example asthma, diabetes, epilepsy, heart condition, concussion history, developmental or behavioural diagnosis)?

Medical Condition – If You Answered “Yes” in the Previous Question; N/A if "No"

Medical information: 3. Allergies (including food, medication, insect bites, grass, tape etc)

Allergy Details – If You Answered “Yes” in the Previous Question; N/A if "No"

Medical information: 4. Is your child currently taking any medication?

Medication Information – For “Yes” Answers in the Previous Question; N/A if "No"

Asthma and anaphylaxis management: 5.1 Does your child have an asthma action plan?

Asthma and anaphylaxis management: 5.2 Does your child have an anaphylaxis plan or require an epi pen?

Medical information: 6. Is there anything else we should know to help support your child safely and confidently at training (for example recent illness, concerns about fitness, anxiety in groups, learning or concentration difficulties)? Please provide details:

Parent or guardian declaration – medical: I hereby confirm that the information above is correct to the best of my knowledge. I acknowledge my responsibility to update Sunshine Coast Sports Training with any changes.

Confirm and Submit

Participant details:

Child’s full name

Participant details:

Date of birth

Participant details:

School and year level

Participant details:

Sport or sports they mainly play

Parent or guardian details:

Parent or guardian name

Parent or guardian details:

Mobile number

Parent or guardian details:

Email address

Emergency contact (if different from above):

Name

Emergency contact (if different from above):

Relationship to child

Emergency contact (if different from above):

Mobile number

Medical information:

1. Does your child have any current or previous injuries we should know about (for example knee pain, ankle sprains, back issues, Osgood, Sever’s, shoulder problems)?

Medical information:

2. Does your child have any medical conditions (for example asthma, diabetes, epilepsy, heart condition, concussion history, developmental or behavioural diagnosis)?

Medical information:

3. Allergies (including food, medication, insect bites, grass, tape etc)

Medical information:

4. Is your child currently taking any medication?

Asthma and anaphylaxis management:

5.1 Does your child have an asthma action plan?

Asthma and anaphylaxis management:

5.2 Does your child have an anaphylaxis plan or require an epi pen?

Medical information:

6. Is there anything else we should know to help support your child safely and confidently at training (for example recent illness, concerns about fitness, anxiety in groups, learning or concentration difficulties)?

Please provide details:

Parent or guardian declaration – medical:

I hereby confirm that the information above is correct to the best of my knowledge. I acknowledge my responsibility to update Sunshine Coast Sports Training with any changes.