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Photography policy

Clubs with Womens/Girls' teams

Go to Club Contact Details
You can print out the Medical  form below, the Availability 2005/6
  and the Application form  and send them to
Glenn Warren, 2 Ham Farm Cottages, Littlehampton Road, Worthing BN12 6PA      		Girls Application Form
Girls Code of Conduct

Medical Questionnaire

Player Name: ___________________________________            Date of Birth: __________________

Parents/Guardian’s name and initials: _________________________________________(if applicable)

Home Address: ________________________________________________________________

______________________________________________________________________________

 Telephone number: _____________________________

 Name and Address of family Doctor: ______________________________________________

 ______________________________________________________________________________

 Telephone number: ___________________________

 Have you had any of the following?

Asthma or Bronchitis     yes                 no
Heart condition     yes  no
Fits, fainting or blackouts     yes  no
Severe headaches   yes  no
Diabetes     yes  no
Allergies to any known drugs or medication    yes  no
Any other allergies e.g. material, food, insect bites     yes  no
Any recent fractures or injuries  yes  no
Any recent bouts of concussion   yes  no

 If the answer to any of these questions is YES please give details:


 

Immunisation Status:

Have you received vaccination against Tetanus in the last years                               yes  no
Date if yes: _______________________________    
Are you currently receiving medical treatment of any kind from either your doctor, a hospital`or physio ?                                                             yes  no
Have you been given any specific medical advice
to follow in emergencies?                                      		yes  no

If the answer to any of these questions is YES please give details:
 

 

Emergency contact details:

  1. Name:_______________________________________  

    Relationship to player:_________________________

          Tel Number:________________________        Mob Number: _____________________

  1. Name:________________________________________    

    Relationship to player:__________________________

         Tel Number:__________________________      Mob Number:  _____________________

Consent for Treatment

I consent to any emergency medical treatment necessary during all training and events.

Signed: _____________________________ Date: ________________

If the player is 18 years of age or under, this must be countersigned by a parent or guardian.

Signed: ____________________  Please print name: ________________

Relationship to player: _________________________________________

This information will be treated as strictly confidential and will be kept with the
Team Manager during all training and tournaments

----------------------------------------------------------------------------------------------------------------------------------------------

Photographs – I give permission for my daughter ……………………………… to appear in general photographs  that may be taken while she is taking part in Sussex coaching or playing.  These may be used in newspapers (not individually named), general advertising for girls rugby, and videos that might be required for GCSE and “A” level exam work.

Signed             ……………………………………………………………………..Parent/Guardian
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