Player Information Form - Essex Spartans A.f.o Page 2

If yes, please give details here:

Do you wear glasses?

YES / NO

Do you wear contact lenses?

YES / NO

Do you wear a hearing aid?

YES / NO

Do you wear a medical alert bracelet or necklace?

YES / NO

If yes, please state what is written on it:

Disclaimer: I understand that all activities I participate in this event are done out of my own risk

and I accept all responsibility. I agree not to bring any claim against the organisers of this activity

or officers involved in the event. I have read and accepted the terms of this liability disclaimer

agreement.

PLAYERS SIGNATURE:

DATE:

EMERGENCY CONTACT DETAILS (MUST be completed by ALL Players)

NAME:

TELEPHONE / MOBILE NO.:

PARENTS/GUARDIAN DETAILS (MUST be completed if player under 18 years)

PARENT/GUARDIAN NAME:

PARENT/GUARDIAN

DATE:

SIGNATURE:

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Parent category: Miscellaneous