Esports Gamer Health and Wellness Declaration Form

Personal Information

Full Name Age Team/Organization Email Address

Health Status

Average Hours of Sleep per Night Average Daily Screen Time (hours) Do you engage in physical exercise regularly? Yes No Do you take regular breaks during gaming sessions? Yes No Do you maintain a balanced diet? Yes No

Medical Declaration

List any current medical conditions Are you taking any medications? Do you have any injuries affecting gameplay?

Consent & Declaration

I confirm that the information provided is accurate and complete.