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  • Player Profile Form: Personal Details

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    jan
    22 views2 pages
    This document is a player profile form collecting personal and medical details of a rugby player. It requests contact information, emergency contacts, medical conditions and history of injuries. It also collects health and fitness information like other sports played, training hours, height and weight. A cardiac questionnaire screens for any heart conditions. The player and profiler must sign confirming the accuracy of the information provided.

    Original Description:

    rugyb player_profile_2011_en

    Original Title

    player_profile_2011_en

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    This document is a player profile form collecting personal and medical details of a rugby player. It requests contact information, emergency contacts, medical conditions and history of injuries. It also collects health and fitness information like other sports played, training hours, height and weight. A cardiac questionnaire screens for any heart conditions. The player and profiler must sign confirming the accuracy of the information provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    22 views2 pages

    Player Profile Form: Personal Details

    Uploaded by

    jan
    This document is a player profile form collecting personal and medical details of a rugby player. It requests contact information, emergency contacts, medical conditions and history of injuries. It also collects health and fitness information like other sports played, training hours, height and weight. A cardiac questionnaire screens for any heart conditions. The player and profiler must sign confirming the accuracy of the information provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 2

    Player profile form

    Personal details

    Name

    Address

    Telephone Mobile

    Email

    Date of birth

    Emergency contact

    Name

    Address

    Relationship to player

    Telephone Mobile

    Medical history

    Do you have any medical conditions, disabilities or allergies?

    If the answer is yes, please list each condition, disability or allergy and any medication you take for it.

    Condition / disability (e.g. asthma,


    Medication (e.g. tablets, inhalers, Frequency (e.g. twice daily, only with
    diabetes, epilepsy, anaemia, haemophilia,
    creams, etc - give drug names) symptoms, etc)
    viral illness, etc)

    Medication (e.g. tablets, inhalers,


    Allergy (e.g. bee stings, etc) Dose / frequency
    creams, etc - give drug names)

    History of injury (list any injuries, when they happened and who treated you)

    When Who treated you Current status of injury


    Injury (e.g. concussion) Treatment received
    (e.g. Sept 2007) (e.g. doctor) (fully recovered or not)

    Rugby Ready / Pre-participation / Player profile


    Player profile form

    Health and fitness assessment

    In which other sports / physical activities are you


    involved?

    How many hours per week do you train?

    Have you played Rugby before?

    If yes, where and for how many seasons?

    Height

    Weight

    Cardiac questionnaire (please tick each box that applies to you)

    Fainting Palpitations

    Dizzy turns Chest pain or tightness

    Breathlessness or more easily tired than team- Sudden death in your immediate family of anyone
    mates under 50

    History of high blood pressure Smoking (how many per day)

    Diabetes

    Signatures

    Date of profile completion

    Player’s signature (or guardian if under 18)

    Profiler's signature

    Follow-up date (if applicable)

    Rugby Ready / Pre-participation / Player profile

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