Player Emergency Information Card

Player Emergency Information Card

***To be given to the Team Coach or Manager***
Players Name:*
Date of Birth (D/M/Y)::*
Address:*
Telephone:*
E-mail Address:*
Person to contact in case of emergency:*
Relationship to player:*
Parent/Guardian’s Name (if under 18):*
Address:*
Home Tel:*
Business Tel:*
Family Doctor:*
Tel:*
IMPORTANT
Are you allergic to any drugs, if so what?*
Do you suffer from any serious illness (please check)*
- Asthma
- Diabetes
- Epilepsy
- Others
- None
Are you on any regular medications, if so what?*
Do you wear contact lenses?*
Other relevant information:*
Registrant's signature or Parent/LegalGuardian if under 18*
Date:*

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