Practice Medical Form

Contact Details
Legal NameRuss Polson
EmailEmail hidden; Javascript is required.
Phone07791308277
TeamMasters Team
Date of Birth26/10/1989
Next of Kin DetailsIn the case of emergency, who is the best person to contact
NameSamantha Polson
RelationSpouse
Phone07792928078
Travel & Accomodation Details
Travel ArrangementCar (Drove Self)
Hotel / Accomodation NameTravelodge Glasgow Central
Others StayingJonny5
Medical
Medical ConditionsYes
Condition Details

Asthmatic - blue and brown inhaler in kit bag

Pre-existing injuriesNo
Medication(s)Yes
Medication Details

Inhalers

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
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