I acknowledge that the information I have provided is to be used as a screening tool for the purpose of coaching and playing.
I hereby certify I believe that to the best of my knowledge, all of the information I have given is correct and true; I have read and understand the above information; I have answered all the questions to the best of my ability; I consider myself to be capable and in good health to participate in this sport and physical activity.
All information provided on this sheet is confidential. Access to this sheet is limited to Melbourne Junior Ice Wolves coaches, team manager, administration and medical team. Your personal details and medical information will not be made available to third parties unless permission to do so is granted by you.