BLOOMSBURY FOOTBALL ACADEMY MEDICAL INFORMATION & CONSENT FORM

PLAYER DETAILS
PLAYER NAME *
PLAYER NAME
PLAYER DATE OF BIRTH *
PLAYER DATE OF BIRTH
PLAYER HOME ADDRESS *
PLAYER HOME ADDRESS
PRIMARY EMERGENCY CONTACT
PRIMARY EMERGENCY CONTACT NAME *
PRIMARY EMERGENCY CONTACT NAME
SECONDARY EMERGENCY CONTACT
SECONDARY EMERGENCY CONTACT NAME *
SECONDARY EMERGENCY CONTACT NAME
PLAYER HEALTH INFORMATION
PHOTO & VIDEO CONSENT
CONSENT OF LEGAL CARER