Medical Questionaire

Player Name

Date of Birth

Emergency Contact (Name & Phone)

Does the player carry any medical items (e.g., inhaler, EpiPen)?

Has the player had any serious injuries or concussions in the past?

Is the player currently recovering from any injury or illness?

Are there any activity restrictions or things we should watch for during practice or games?

Any other notes or concerns you'd like the coach to know?

Does the player have any allergies (e.g., food, medication, insect stings)?

Does the player have any medical conditions (e.g., asthma, diabetes, seizures)?

Any other notes or concerns you would like the coach to know?

by typing your full name and email you agree this information can be shared with your childs coach

What age group is your child registered in?

intro

u11

u13

u15

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Westlock Soccer Association © 2025

The Westlock Soccer Association is run by volunteers dedicated to providing an affordable and enjoyable soccer experience for children. We deeply value our coaches for their role in teaching skills and fostering a positive environment. With low fees and a focus on player development, we give kids the chance to grow, have fun, and enjoy the game.