12 in stock

Player Details

Name: (June 2022) - Year 2/U7
SKU: 16633
Price: 7.00 GBP
Availability: InStock

Player Name*

Address*

Date of Birth*

School Year*

Current Club*

Previous Clubs

Position*

Parent/Guardian Name*

Parent/Guardian Phone Number*

Medical Health Screen

Has the player ever experienced:

Chest pain with or without exercise?*

Excessive unexpected or unexplained fatigue with exercise?*

Heart palpitations (heart races or skips beats) during exercise?*

Dizziness or collapse with exercise?*

Wheezing or tightness in the chest during exercise?*

Past detection of a heart murmur or high blood pressure?*

A fracture dislocation or major injury to any joint?*

Does the player suffer from:

Diabetes?*

Asthma?*

Seizures?*

Allergies?*

Fainting attacks?*

Is there a family history of any of the above problems (excluding allergies)? If so please give further details below

Do you take any regular medication if yes give further details below.

Have you suffered any back joint or muscular injuries in the past?

Do you have any other medical conditions not mentioned?

Has anyone in the player's family:

Died of a heart problem or sudden cardiac arrest before the age of 50?*

Had unexplained seizures?*

Suffered from a genetic cardiovascular condition e.g. Hypertrophic cardiomyopathy Marfan syndrome?*