Wheelchair Basketball Player Health Disclosure Form
Personal Details
Full Name
Date of Birth
Team/Club
Email Address
Phone Number
Medical Information
Type of Disability/Condition
Relevant Medical History
Allergies (medication, food, environmental)
Current Medications
Emergency Contact Name
Emergency Contact Phone
Consent & Declaration
I consent to medical treatment in case of emergency.
I declare the information provided is accurate and complete.
Signature
Date