Player Medical Information Form

ALL INFORMATION PROVIDED WILL BE KEPT STRICTLY CONFIDENTIAL AND WILL ONLY BE USED FOR THE PURPOSES OF PROVIDING MEDICAL MANAGEMENT IN THE EVENT OF ILLNESS OR INJURY.

Year*

2024

Soccer or Golf*

Soccer Golf

Is there any Medical Condition or any other Condition we need to be aware of whilst you are attending and travelling to / from Fiji Cup?*

Yes No

Are any of the conditions likely to affect your performance?*

Yes No

I declare I am not consuming, administering or in possession of illegal substances and / or drugs.*

I am not

To the best of my knowledge, the information provided is complete and correct.*

Yes, information correct