Touch Football Medical Clearance Form printable pdf download

Touch Football Medical Clearance Form

TOUCH FOOTBALL

MEDICAL CLEARANCE FORM

Doctor

My patient____________________________________, wishes to participate/ continue to participate in Touch

Football competitions and/or Touch Football related activities, after having discussed their medical condition(s)

with me. He/ She has been advised of all risks associated with participating and understands the possible

consequences.

Physician’s Recommendations

Provide

information

relating to the

condition. Use

the interactive

diagram of the

body to indicate

injured body

parts.

Signature:

Contact Number:

Name (please print):

Date:

Patient Consent/ Disclaimer

, consent to participate in Touch Football competition(s) and/or

Touch Football related activities coordinated by (insert affiliate name)

I have sought medical advice by the above physician, and have been advised of all risks and consequences

associated with my pre-existing and/or current medical condition(s).

I also understand whilst participation is actively encouraged at all levels in Touch Football, the insurance cover

purchased by Touch Football Australia (TFA) will not respond to some pre-existing medical conditions and that I

continue my involvement at my own risk.

Signature:

Date:

FOR STATE/ TERRITORY ADMINISTRATOR (OFFICIAL USE ONLY)

Date Received:

OfficeApproved:

Approved by:

Touch Football Australia Inc.

1/18 Napier Close, Deakin ACT 2600

p. 02 6212 2800 | A01092 | ABN: 55 090 088 207

Touch Football Medical Clearance Form