BWHA Medical & Consent Form 2025 - Brisbane Women's Hockey Association

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All players and officials representing BWHA at a tournament must complete a Medical Form prior to the tournament they are attending. This information will remain private and confidential and be retained in our system until the end of the Calendar year (December 31 2025).

If you have further supporting documents or information that needs to be provided, please upload via the tab provided. Please speak to your team manager if you need to discuss further.

Enter your email address*

Legal Disclaimer and Consent Agreement*

I, as the participant (or the parent/guardian of the participant named on this medical form, if the participant is under 18 years of age), give my consent for participation in the above tour under the supervision of BWHA-authorised personnel. I acknowledge that all BWHA rules and regulations will apply at all times. Supervision will be provided in a manner that ensures the safety and well-being of all participants. Any failure to comply with the required standards of conduct may result in the participant being sent home at their own or their parent/guardian’s expense. I further understand and agree that the authorised personnel in charge of the tour have the authority to act on my behalf in the event of an emergency, including seeking medical or surgical treatment if necessary. I accept responsibility for reimbursing BWHA for any medical expenses incurred in such circumstances. I understand that, if emergency medical treatment is required, the authorised personnel will make every effort to contact me as soon as possible. Additionally, I authorise qualified medical practitioners to administer anesthesia, transfusions, or other necessary medical procedures if required. I acknowledge that all reasonable precautions will be taken by BWHA and its authorised personnel to ensure the safety and well-being of participants. However, I agree not to hold BWHA or its authorised personnel responsible for any unforeseen incidents beyond their reasonable control.

I consent to the terms and conditions outlined above

Who is completing this form?

Parent/Guardian

First Name (Parent/Guardian)

Last Name (Parent/Guardian)

Team

Team 6 & 7

Date of Birth (Player)*

Emergency Contact

First Name (Emergency Contact)

Last Name (Emergency Contact)

Phone Number (Emergency Contact)

(If mobile number, please add 61 in front of your number and leave off the 0)

Medicare Number (including reference number)*

Medicare Cardholder Name*

Immunisation Records

Tetanus (Date of last booster)*

Hepatitis B Vaccination

Meningococcal C Vaccination

Medication

Please give full details of any prescribed medication being taken (including dosage, frequency and any doctors instructions) if medical plan in place please submit separately below*

Medical History

Do you suffer from any of the following? (Please provide relevant information in Medical Management if yes)

Asthma*

If yes, please specify details in Medical Management

Food Allergies

Do you have any food allergies*

Yes

Medical Management

Food Allergy List

Please list any food allergies team officials need to be aware of (eg Dairy, Wheat, Vegan etc)

Medical Management Plan

Medical Management Plan Submission (if applicable)

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