Medical and Injury Form

We’re excited to have your child join our training sessions! Please fill out the short form. Please be as detailed as possible.

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Question 1 of 22

Participant details:

Child/Children’s full name(s):

(Please list all children attending)

Paragraph answer

Question 2 of 22

Participant details:

Date of birth:

(If registering multiple children, please list each DOB)

Paragraph answer

Question 3 of 22

Participant details:

School and year level:

(If registering multiple children, please list each)

Paragraph answer

Question 4 of 22

Participant details:

Sport or sports they mainly play:

(If registering multiple children, please list per child)

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/children 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/children 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/children 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/children 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/children have an anaphylaxis plan or require an EpiPen?

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/children 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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Medical and Injury Form

Click the button below to start.

Participant details: Child/Children’s full name(s): (Please list all children attending)

Participant details: Date of birth: (If registering multiple children, please list each DOB)

Participant details: School and year level: (If registering multiple children, please list each)

Participant details: Sport or sports they mainly play: (If registering multiple children, please list per child)

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/children 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/children 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/children 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/children have an asthma action plan?

Asthma and anaphylaxis management: 5.2 Does your child/children have an anaphylaxis plan or require an EpiPen?

Medical information: 6. Is there anything else we should know to help support your child/children 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/Children’s full name(s):

(Please list all children attending)

Participant details:

Date of birth:

(If registering multiple children, please list each DOB)

Participant details:

School and year level:

(If registering multiple children, please list each)

Participant details:

Sport or sports they mainly play:

(If registering multiple children, please list per child)

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/children 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/children 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/children currently taking any medication?

Asthma and anaphylaxis management:

5.1 Does your child/children have an asthma action plan?

Asthma and anaphylaxis management:

5.2 Does your child/children have an anaphylaxis plan or require an EpiPen?

Medical information:

6. Is there anything else we should know to help support your child/children 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.