As a community organisation run by volunteers, we must ensure that the appropriate action is taken if our players have an existing medical condition, is ill or experiences an injury whilst playing for the club. Whilst all care and consideration is taken by the Coaches and Managers of your team, occasionally there may be a need to administer medication and/or first aid, either during training or at matches. The Coaches and Managers take no responsibility for the administering of medicines except in the case of emergencies where an injury has taken place at training and only then with the written permission as stated in this form.

To ensure we as a club have the knowledge at hand to care for the players when required, please complete the form below and return to your team Manager or Coach, at your next training session.

Players Name______

Team Name______

Medical History

  1. Is the player taking any medication at present? Please Circle…YesNo
    If Yes, please provide details and management plan for any condition (eg. Asthma, Epilepsy etc)

______

______

Note: For training and matches, please ensure that any medication is clearly labelled with the
player’s name and how/when the medication should be administered.

2. Are there any medical conditions which may occur that Coaches and Managers should be aware of?
Please Circle…YesNo

If Yes, please provide details of the condition and appropriate management plan.

______

______

  1. Are there any allergies of which the Coaches and Managers should be aware? (eg. Oranges, Nuts etc)

______

______

  1. Are there any known First Aid complications of which the Coaches and Managers should be aware?
    (eg. Band-Aids, Analgesic Creams, Paracetamol etc)

______

______

Permission

I permit the Coach or Manager to attend to the First Aid or Medical Needs where required, as per the
above stated information.

______

Parent/Carer NameSignatureDate