BWHA U12 Medical & Consent Form 2026 - Brisbane Women's Hockey Association

· ·

Please complete this form without logging in.

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 2026).

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.

Download

Enter your email address*

Player/Official Name:*

First and last name

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

Team Selected*

Player/Official Date of Birth*

Who is completing this form?*

Parent/Guardian (First and Last):

Emergency Contact

Emergency Contact (First and Last):*

Phone Number (Emergency Contact)*

Please start with 61 and leave off the 0

Medicare Cardholder Name*

Medicare Number (including reference number)*

Immunisation Records

Tetanus (Date of last booster)*

Hepatitis B Vaccination*

Meningococcal C Vaccination*

Medication

Please give full details of any prescribed medication being taken (dosage, frequency, doctor instructions, medical plan, etc)

Please note: A medical management file can be uploaded at the end of this form

Medical History

Does the player/official suffer from any of the following?

Asthma*

If yes, please specify details in Medical Management

Food Allergies

Does the player/official have any food allergies?*

Food Allergy List

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

Medical Attachments

Medical Management Plan

Medical Management Plan Submission (if applicable)

Choose file...

Max 5MB

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.