Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Questionnaire Dear Parents/ Guardians, Brent and I have just provided a short questionnaire for you to fill out. As first aiders we need to know whether your child suffers from any of the conditions below:Player NameIs your son a diabetic? *Please SelectYESNO he not Name Has your son ever had an allergic reaction or does he suffer from any allergies that you are aware of? *Please SelectYESNODoes your son carry an Epi Pen? *Please SelectYESNODoes your son suffer from asthma? *Please SelectYESNODoes he use an inhaler? *Please SelectYESNODoes your son have any underlying heart conditions? *Please SelectYESNOAny conditions not listed...Injuries to be aware of...I, or the person on whose behalf I am completing this form, acknowledge and agree that the information provided in this Questionnaire is true and correct. I understand that the personal and medical information provided will be used for registration, insurance, program management purposes, and in the event of accident, injury and/or illness to the participant. I acknowledge that Boomfit Football Academy will not be liable in the event any information provided in this Questionnaire is found to be false or incorrect and I agree to indemnify Boomfit Football Academy for all loss that may arise from relying on the information contained in this Questionnaire. Program Boomfit Football Academy will not be liable for any accident, injury or illness which may occur as a result of the participant complying with this Program, or misusing the Program. If the participant experiences any pain or discomfort then Boomfit Football Academy advises that the participant stop following the Program immediately and contact their medical practitioner. Name of Parent / Guardian *Parent / Guardian Signature (copy) * Clear Signature Sign with mouse or finger on mobile & tabletDate of Signature *SIGN QUESTIONAIRE
