The following shall be completed by the parent or care giver for the player intending to play for Gracemere JRL. Please print the players full name in the following text box

Do you have Private Health Insurance? if yes please nominate name of Fund

Do you have Medical Number ? If yes please confirm medicare number

Are you under a physicians care? If yes please explain

Have you been hospitalized or any operations in the past year? If so please explain when and why

Have you ever suffered from frequent chest pains/palpitations or history of rheumatic fever ? if yes please explain

Do you have any allergies including hives or reactions to bee stings? If yes please explain

Do you have any recent history of fatigue or undue tiredness? Fainting with exercise? If so please explain

Do you have asthma or get shortness of breath? if yes please confirm type of medication you have been subscribed my a medical practitioner

Do you have a vision impairment? if yes please explain if you are required to wear Glasses etc.

Is there any other information that Gracemere Cubs coaching staff and First Aid Officer may need to be aware off?

I hereby give permission for the above named player to participate in all Junior League Activities and for the GJRL to authorize any medical treatment deemed necessary by a qualified physician for my child in the case of an emergency. This consent is in the event that I am not present at training or a game of football. I understand that some of the above questions are very personal, but totally understand the commitment to safety the club is providing for my child and should my child be taken to hospital these are standard questions asked.
Please complete your name and sign

Are you willing to help out in the following areas, working bee, Canteen, team building, match report/time keeping, Game day setup/pack away, Ground Official and Fundraising. If yes please choose which duty(more than can be chosen)

Do you have a current blue card, if yes please advise the number

Would you like to be involved in coaching, managing, league safe, FAO for the Gracemere JRL? If yes please advise age group and the preferred role

Please confirm your Shirt Size

Please confirm your Short Size

Do you approve of photo's taken and published on social media sites or other sites to promote the Gracemere Cubs