2023 WA Squash Junior Medical Form

Parent's Name *

First

Last

Email *

Mobile Number *

Child's Name *

First

Last

Family Doctor's Name *

Family Doctor's Clinic Name *

Family Doctor's Phone Number *

Is your child affected by any physical medical conditions? If yes, please specify, and include management of the condition. *

Is your child affected by any mental conditions? If yes, please specify, and include management of the condition. *

Does your child have any dietary requirements, allergies or food intolerances? If yes, please specify. *

Consent to medical attention and treatment. *

I authorise the squash clinic's head coach to consent to medical or surgical treatment on my behalf, as may be deemed necessary for my child, if it is impractical for prior communication with me, and agree to pay all medical and/or dental expenses incurred.

Squash WA

The Healthiest Sport in the World

2023 WA Squash Junior Medical Form

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