JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Rainbow Gold Enduro Athlete Information and Medical Form
To be filled out by all athletes and swim leg board assisit paddlers competing in the Rainbow Gold Enduro
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Full Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Email
*
Your answer
Contact number
*
Your answer
Emergency contact name
*
Your answer
Emergency contact number
*
Your answer
Relationship to Emergency contact
*
Your answer
Have you had any recent breaks from training due to injury or illness?
*
Yes
No
Required
Check any that have recently occured or apply to you :
*
Broken bone or Injury to a joint
Concussion / Loss of consciousness
Chronic Illness
Contact with a confirmed case of Covid 19
Recent surgery
None of the above
Required
Do you have any of the following medical conditions?
*
Asthma
Diabetes
Epilepsy
Heart condition
None of the above
Required
Do you take any regular medication?
*
Yes
No
Required
Please list any medications ,or any other details you think may be relevant.Please bring any medications you might need with you on the day.
Your answer
Athlete declaration
*
I confirm that the above information is correct
Required
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
