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2025 Regional Girls Training Camp – Medical and Health Information

Before you proceed to the form, we’d like to assure you that your privacy and confidentiality are of utmost importance to us. The personal medical information you provide is critical in helping us ensure a safe and healthy working environment for you and your colleagues. Your data will not only assist us in offering the right medical treatment if needed, but it also facilitates effective emergency response procedures. We strictly adhere to the highest standards of data privacy and protection. Your information will remain strictly confidential and will only be disclosed to appropriate parties if an emergency situation necessitates it. We appreciate your trust in us as we continue to strive towards your safety and well-being.

"*" indicates required fields

1. Personal Details

Please enter your personal details.
Name*
DD slash MM slash YYYY

2. Emergency Contact

Please enter details of the person we should contact in the event of an emergency.
Contact name*

3. Medical Information

Please complete the medical information below.
DD slash MM slash YYYY
Do you suffer from any of the following?*
Are you required to take prescription medication during the tour?*
Do you have pre-existing injuries or illnesses that we should be aware of?*
Do you have any special dietary needs?*

4. Healthcare Information

Please provide your Medicare and Private Health Insurance details.
Do you have private health cover?*
Does your policy include ambulance cover?*

5. Additional Information

Please provide any further information you feel will be of assistance in the box below.

6. Declarations

Football West Touring Team Code of Conduct*
Consent*
This field is for validation purposes and should be left unchanged.

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