Practice Medical Form

Contact Details
Legal NameMichael French
EmailEmail hidden; Javascript is required.
Phone07305199328
TeamMasters Team
Date of Birth02/10/1987
Next of Kin DetailsIn the case of emergency, who is the best person to contact
NameKate french
RelationSpouse
Phone07306443793
Travel & Accomodation Details
Travel ArrangementTrain
Hotel / Accomodation NameDoubletree by Hilton
Others StayingWife and kids
Hotel / Accomodation Comments

It’s lovely

Medical
Medical ConditionsNo
Pre-existing injuriesYes
Injury Details

Ankle sprain, sore hip

Medication(s)No
AllerigiesNo
CommentsAre there any other items that you believe the Coaches/Organisations should be made aware of?
Agreements
Authority reporting Approval
  • agreed
Insurance Coverage
  • agreed
Medical Release
  • agreed
Sealand Seahawks

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