High Performance: Elite Athlete Medical Form - 2022/23
Name
Name
First
Last
Squad
Role
Address
Address
City
State/Province
Zip/Postal
Country
Are you of Aboriginal and/or Torres Strait Islander origin?

Consent

Please agree to the following statements regarding the collection and use of infomation collected via this form.
By completing this form, I consent to the collection of this information by Bowls SA for the purposes of medical treatment at Bowls SA tournaments, events or programs in accordance with the provisions of the Privacy Act 1988 (Cth).
I understand and agree that Bowls SA may only use or disclose this personal information to third parties, including approved Bowls SA engaged coaches/team managers/event providers for the purpose of my duty of care, OR to emergency service providers, for the purposes of medical treatment or any other directly related purpose.
Further I understand that if I do not supply any or all of the required information it will impact on the provision and effectiveness of any medical treatment rendered to me if required.
Name of parent/guardian completing this form on behalf of the athlete ( Only applicable to athletes under 18 years of age)
Name of parent/guardian completing this form on behalf of the athlete ( Only applicable to athletes under 18 years of age)
First
Last

General Medical History

Please provide details regarding your general health history

Allergies and Dietary Requirements

Please provide details regarding any allergies or dietary requirements.

Injury History

Please provide details regarding any current or historical injuries.

Medical & Allied Health Providers

Emergency Contact Details

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