Stonehaven 2022 Registration

Stonehaven 2022 RegistrationColin Burgess, Sailing Coordinator2021-07-15T14:11:05+10:00

Stonehaven Participant Registration and medical form 2022

Participant Name

First

Last

Participant Email

Participant Club

Participants Phone

Participants Australian Sailing Number

Participants D.O.B

Have you passed a swimming assessment

Yes

Do you have approved safety gear(incl buoyancy vest & protective clothing)

Yes

By entering I agree to the below

Participant Signature

Clear

Parent/Guardian

First

Last

Parent Phone - Business hours

Parent Phone - After hours

Parents Email

Stonehaven Indemnity Form

We have read the Stonehaven Indemnity form

yes

Confidential medical Information (This information is intended to assist in case of a medical issue or emergency. All participants are to complete this form as a pre-requisite for entering the Stonehaven Cup Regatta.)

Contacts details of family Doctor

Medicare Number

Medical Fund

Medical Fund Number

Text

Does participant suffer from any of the following

Allergies to

Penicillin

Other Drugs - SpecifyOther Drugs - Specify

Foods - SpecifyFoods - Specify

None

What Special care is recommended

Dietary requirements

Year of last tetanus immunisation

Are you full COVID Vaccinated

Yes

Is participant taking tablets and/or medicine

Yes - State medication name, dosage etcYes - State medication name, dosage etc

Medical Attention

Signature Of Participant

Clear

Signature of Parent/Guardian

Clear

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