Athlete's Full Name

Date of Birth

Address

Postcode

Sport(s)

Club(s)

Level (i.e. regional, national, international)

Medical Information

Do you suffer from any conditions requiring medical treatment, including medication or allergies?
YesNo

If yes, please can you tell us what conditions, medications, and any allergies we should be aware of.

Please note any current or previous injuries you have that may impact on your safety while training.

Is there any other information, not listed above, that it would be appropriate for your S&C coaches to be aware of?

Parent/Guardian Info

Full Name

Contact Number

Email address

Address

Declaration

The information given above is both accurate and complete and I undertake to inform ANGUSalive as soon as possible of any change. I agree to receive first aid and medical treatment and care where appropriate.

I agree

Applicant Signature

Signature of Parent/Guardian