Sharks Junior Football Club » Medical and Consent Form

Welcome to the brand new online Medical and Consent Form system! This form replaces the requirement for completing and submitting a paper-based form, reducing paperwork requirements on both ends!

The form is split into three main steps. You cannot proceed to the next step until you have successfully completed the prior step. Please read all instructions carefully and ensure that you provide complete, accurate details.

If you enter data that is not valid, the system will not allow you to proceed – the issues will be highlighted in red next to the field with the error. Review, correct, and re-try if you encounter such errors.

Don’t worry – you have as much time to complete this form as you need. It will not “time out”, and if you’re using a modern computer or tablet, it should remember what you entered even if you refresh the page!

If you find that something isn’t working correctly, please email the Webmaster with a description of exactly the data you entered, and the error it gave you. We’ll endeavour to correct this ASAP!

Consent

Step 1: Consent

Please read all sections carefully. This form must be completed and submitted before a player is considered eligible to play.

Family Information

Please provide your surname and email address so we can send you a copy of the information you provide

Family Name *

Email Address *

Players

Provide details of the player(s). At least one player must be provided, up to three additional players may be added as required.

Number of players *

Select the number of players you wish to register

Player 1 *

Date of Birth *

Player 2

Date of Birth

Player 3

Date of Birth

Player 4

Date of Birth

Parents and/or Guardians

Provide details of the parent(s) and/or guardian(s) of the player(s). At least one parent/guardian must be provided, up to two additional parent(s) and/or guardian(s) may be added as required.

Mother/Guardian 1 *

Phone *

Father/Guardian 2

Phone

Parent/Guardian 3

Phone

Terms and Conditions

Please read and agree to the below Terms and Conditions, including Photography Release, Fees and Levies, and Code of Conduct.

Photography Release

From time to time, the Park Orchards North Ringwood Parish Junior Football Club may use images of players, officials and parents for promotional purposes. Completion of this form acknowledges you have read and agreed to this use.

Fees and Levies

The Park Orchards North Ringwood Parish Junior Football Club makes available football jumpers for use by registered players, but these remain the property of the club. A $150 fee will be levied for jumpers not returned when requested. Completion of this form acknowledges you have read and agreed to these fees and levies.

Code of Conduct

All players, coaches, and parents must read and agree to abide by the Yarra Junior Football League Code of Conduct, available by clicking here. It is extremely important, for the good of the club, that all club members understand and adhere to the guidelines of the Code of Conduct. Completion of this form acknowledges you have read and agree to abide by these rules.

Agreements *

I, the parent/guardian, have read and agree to the Photography Release

I, the parent/guardian, have read and agree to the Fees and Levies

I, the parent/guardian, have read and agree to abide by the Code of Conduct

I, the player(s), have read and agree to abide by the Code of Conduct

Medical

Step 2: Medical Details

Provide details of your healthcare provider, insurance, and any medical conditions.

General Practitioner

Provide the details of your family GP.

Doctor's Name

Practice Name *

Phone *

After Hours Phone

Address *

Suburb *

Postcode *

Dentist

Provide the details of your family dentist.

Dentist's Name

Practice Name *

Phone *

After Hours Phone

Address *

Suburb *

Postcode *

Medicare

Please provide your Medicare Card Number, the name of each player exactly as it appears on your Medicare card, and their associated Individual Reference Number (IRN). The IRN is the single-digit number preceding the name listed on your Medicare Card.

Medicare Card Number *

Player 1 IRN *

Name on Card *

Player 2 IRN

Name on Card

Player 3 IRN

Name on Card

Player 4 IRN

Name on Card

Private Health Insurance

If relevant, provide the details of your Private Health Insurer

Do you have Private Health Insurance? *

Yes

Private Health Fund

Member Number

Medical Conditions

Please provide details of any relevant medical conditions or special needs for your child, e.g. allergies

Medical Conditions or Special Needs

Insurance

The Park Orchards North Ringwood Parish Junior Football Club strongly recommends that all Players, Coaches, and Team Officials who participate in training and match day duties, be members of a Medical Benefit Association, and be covered by insurance for their own protection. The Park Orchards North Ringwood Parish Junior Football Club does not cover any medical expenses or any costs due to insurance gaps, however limited insurance cover is provided through our cover with JLT Sport and the YJFL. This may be of some benefit to you in the event of an injury sustained whilst performing your duties at training or on match days.

It is hereby acknowledged that the Park Orchards North Ringwood Parish Junior Football Club Inc. is not in any way responsible for any liability or expense whatsoever and that we will make no claim against the club or its members as a result of any injury to playing members while participating in any activity nominated by the club.

Agreement *

I, the parent/guardian, have read and agree to the Insurance information

Verification

Step 3: Verification and Submission

Provide confirmation of all provided data, your feedback, and submit the form.

Volunteers

Park Orchards North Ringwood Parish Junior Football Club is a junior sporting organisation that relies upon volunteers at all levels to help create a successful and well run club for players and their families. We are constantly in need of volunteers and would appreciate an indication of where you might be able to assist.

Other Volunteering Details

Feedback

Congratulations, you have provided all required details! If you have a moment, we would love to hear your feedback on the online form process. Did you have any difficulties understanding or completing a section? Is something missing or not working correctly? Is it too difficult to follow? We want to know!

Acknowledgement and Authorisation *

To the best of my knowledge, all information contained on this form is true, accurate, and complete. I authorise Park Orchards North Ringwood Parish Junior Football Club Inc. to provide first-aid and consent, where it is impractical to communicate with either the Emergency Contact or person in whose care the player has been placed for the day (e.g. at the game), to the player receiving medical or surgical treatment as may be deemed necessary.

I, the parent/guardian, have read and agree to the Acknowledgement and Authorisation

Humanness Test *

This ensures that you are a real human being

reCAPTCHA is required.

Submit

You MUST press the Submit button below to submit your form. If you need to make any changes in the future, please contact your Team Manager. All data provided will be handled in accordance with all applicable privacy laws.