Player Medical Form – Fill Out and Use This PDF

The Player Medical Form is designed to compile essential health information for individuals engaging in sports, specifically within the context of Hockey Canada. This comprehensive document gathers details such as personal identification, medical history, emergency contacts, and relevant health conditions that could impact participation in hockey activities. To ensure the safety and well-being of all participants, it is crucial to complete this form accurately and keep it updated with any changes in the player's health status. Ensure your player’s safety by clicking the button below and filling out the Player Medical Form today.

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Player Medical Form PDF Details

The Hockey Canada Player Medical Information Sheet plays a vital role in ensuring the well-being and safety of participants in the sport. This comprehensive form is designed to gather essential information about a player's health history, current medical conditions, and emergency contact details, providing a robust framework to address health concerns promptly and effectively. It requests basic personal information, including the player's name, date of birth, and contact information, ensuring they can be easily identified and reached. Importantly, the form delves into medical specifics such as the player's provincial health number, names and contact details of the parents, and an alternate emergency contact, should the parents be unavailable. To further safeguard the player's health, the form asks detailed questions about previous medical history including concussions, fainting episodes, heart conditions, illnesses, surgeries, and any current injuries, underlining the importance of understanding the player's fitness and readiness for participation. Additionally, it inquires about medications, allergies, medical conditions, recent injuries, and even the date of the last tetanus shot, emphasizing the commitment to a holistic view of the player's health. The form acknowledges the dynamic nature of a player's health status by urging updates on any changes, and by requiring authorization for medical treatment in emergencies, it ensures that players receive timely care, reflecting a thorough and mindful approach to health and safety in youth sports.

Question	Answer
Form Name	Player Medical Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	hockey canada health form, canada hockey sheet, canada hockey player medical form, hockey canada player medical form

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HOCKEY CANADA

PLAYER MEDICAL INFORMATION SHEET

Name: ____________________________________________________________________________________

Date of birth: Day __________ Month __________ Year __________

Address: __________________________________________________________________________________

Postal Code: _________________________________ Telephone: _________________________________

Provincial Health Number: __________________________________________________________________

Mother’s Name: ____________________________ Father’s Name: ______________________________

Business Telephone Numbers: Mother _____________________ Father ________________________

Person to contact in case of accident or emergency, if parents are not available.

Name: _________________________________________ Telephone: _________________________________

Address: ____________________________________________________________________________________

Doctor’s Name: _________________________________ Telephone: _____________________________

Dentist’s Name: ________________________________ Telephone: _____________________________

Please circle the appropriate response below pertaining to you child

Yes	No	Previous history of concussions
Yes	No	Fainting episodes during exercise
Yes	No	Epileptic
Yes	No	Wears glasses
Yes	No	Are lenses shatterproof?
Yes	No	Wears contact lenses
Yes	No	Wears dental appliance
Yes	No	Hearing problem
Yes	No	Asthma
Yes	No	Trouble breathing during exercise
Yes	No	Heart Condition
Yes	No	Diabetic
Yes	No	Has had an illness lasting more than a week in the past year
Yes	No	Medication
Yes	No	Allergies


		HOCKEY CANADA SAFETY PROGRAM

HOCKEY CANADA

Yes	No	Wears a medic alert bracelet or necklace.
Yes	No	Does your child have any health problem that would interfere
		with participation on a hockey team?
Yes	No	Surgery in the last year.
Yes	No	Has been in hospital in the last year.
Yes	No	Has had injuries requiring medical attention in the past year.
Yes	No	Presently injured.

Please give details below if you answered “Yes” to any of the above items.

____________________________________________________________________________________________________________

Use separate sheet if necessary

Medications: _____________________________________________________________________________

Allergies: __________________________________________________________________________________

Medical conditions: ______________________________________________________________________

Recent Injuries: ___________________________________________________________________________

Last Tetanus Shot:________________________________________________________________________

Any information not covered above:______________________________________________________

___________________________________________________________________________________________________

Date of last complete physical examination: _____________________________________________

*Any medical condition or injury problem should be checked by your physician before participating in a hockey program.

I understand that it is my responsibility to keep the team management advised of any change in the above information as soon as possible and that in the event no one can be contacted, team management will take my child to hospital/M.D. if deemed necessary.

I hereby authorize the physician and nursing staff to undertake examination investigation and necessary treatment of my child.

I also authorize release of information to appropriate people (coach, physician) as deemed necessary.

Date: ____________ Signature of Parent or Guardian: __________________

HOCKEY CANADA SAFETY PROGRAM

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5. To finish your form, this last area incorporates several extra blanks. Filling in Medical conditions, Recent Injuries, Last Tetanus Shot, Any information not covered above, Date of last complete physical, Any medical condition or injury, before participating in a hockey, I understand that it is my, of any change in the above, and I hereby authorize the physician will certainly finalize the process and you will be done very quickly!

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Player Medical Form – Fill Out and Use This PDF

Player Medical Form PDF Details

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