DUWF Health and Safety/Medical Form 

 

 

 

 

 

(This form requests important information that will enable us to better manage the health and safety of anyone who intends to train with or represent DUWF/BTUWF).

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Please return this form to duffersunited@virginmedia.com

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If you are unable to complete and email the attached form please email the answers to all of the following questions to duffersunited@virginmedia.com

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1. Full Name

2. Date of Birth

3. Address

4. Town/City

5. County

6. Post Code

7. Home Tel no.

8. Mobile Phone no.

9. Emergency contact name

10. Emergency contact Tel no.

11. Medical conditions

12. Medication

13. I want to register to play in the Wales Walking Football League Yes/No

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On completing this information you are giving Duffers United Walking Football permission to use the above information for the following purposes:

 

• Contact my emergency contact in case of emergency

• Pass medical information to emergency services

 

Duffers United Walking Football will store the above information securely and will use it only for the purposes declared above.

 

Duffers United Walking Football will not pass the above information to a third party other than for the purposes of assisting emergency services

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