Judo Form

Full Name ^*

Civil ID ^*

Date of Birth ^*

Mobile ^*

Mother ID

Current School ^*

What is the sports club or sports academy?

Does the talent have heart problem ? ^*

Yes

No

Does the talent ever had chest pains brought on by physical exertion ? ^*

Yes

No

Does the talent have high or low blood pressure ? ^*

Yes

No

Does the talent have a skeletal, back or muscular problem that may be aggravated by exercise ? ^*

Yes

No

Does the talent suffer from asthma or allergies ? ^*

Yes

No

Does the talent suffer from epilepsy ? ^*

Yes

No

Does the talent suffer from diabetes? ^*

Yes

No

please provide a doctor’s certificate stating that your talent is fit to exercise.

Promise ^*

I hereby confirm that my child, as stated above, does not suffer from any health problems or additional reasons of any kind, which could contribute to a physical breakdown or any other physical ailment whilst participating in Scouting events and related activities.

Agreements ^*

Yes I agree to the Terms & Conditions

Judo Form

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