Skateboarding Competition Participant Health Form
Participant Information
Full Name
Date of Birth
Age
Sex
Male
Female
Other
Prefer not to say
Address
Phone Number
Email
Emergency Contact
Name
Relationship
Phone Number
Medical Information
Do you have any medical conditions or allergies?
Are you currently taking any medications?
Recent injuries/surgeries?
Physician Name
Physician Phone
Consent
I consent to emergency medical treatment if necessary.
I understand and assume the risks of participation.
Participant Signature
Date
Parent/Guardian Signature (if under 18)
Date