Medical Form | UndyAFC

Undy AFC Medical Declaration

All registered senior players (1st, 2nds, 3rds, U19s, Women & Saturday Ladies) need to complete the following medical declaration as part of your registration with the Club. Your registration will not be processed unless this form has been completed. For further information, please contact Gemma Martin via gmundyafc@gmail.com

Player Details

Player Full Name

Date of Birth

Address Including Post Code

Home Tel No

Mobile Tel No

Emergency Contacts

First Contact Name

Relationship

Home Tel No

Mobile Tel No

Second Contact Name

Relationship 2

Home Tel No 2

Mobile Tel No 2

Medical Details

GP Name

Medical Practice

GP Telephone Number

Details of any known special dietary requirement/allergy/disability/medical condition or type none

Please provide a brief description of the effects of your disability or medical condition and any particular needs you may have or type none

Any other special needs, requirements, or directions that would be helpful for the coaches to know about or type none

Your Name

Date

Note: It is the responsibility of the player, or if the player is under 18 their parent/guardian, to notify the club of any changes to this declaration and by completing this form you give consent for the appointed first aider to administer basic first aid or to take whatever action deemed appropriate in an emergency situation. This form will be retained by the team coaches for reference during matches and training sessions. The completed forms will be stored in accordance with the Club's GDPR guidelines, for further information please contact info@undyafc.co.uk.

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