2025 Hockey WA U14s Medical and Welfare - Hockey Western Australia

Hello Families and Athletes,

The following questions not only relate to medical but general well-being of your athlete when travelling out of State and staying together in a championship bubble. Performance is not soley skills based but viewing our athletes as a whole person, doing our very best to meet the needs of the athlete while in our care. This information is soley reviewed with this outcome. Your transparency and honesty is greatly appreciated and where the question is not applicicaable please answer NA. If you need to discuss any matters privately, please reach out directly to Jo Vaauli, Performace and Pathways Lead HWA, email joanna.vaauli@hockeywa.org.au.

Thank-you in advance,

HWA and your Travelling Off Field Team

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Travelling Athlete Full Legal Name*

Can we please take a small head shot photo for quick identification purposes?*

Name of person completing form?*

Relationship to Athlete*

Traveling Athlete Date of Birth*

Travelling Athlete Team*

In an emergency situation we should contact:*

Emergency Contact Mobile Number*

Relationship of Emergency Contact to Athlete*

Is the Emergency Contact person travelling to the Championship?*

Please list any/all parents attending championship?*

Please provide Athletes Dr. Name*

Please provide Athletes Dr. Phone Number*

Please provide Athletes Dentist Name*

Please provide Athletes Dentist Number*

Please provide Medicare Number*

Please provide Medicare Expiry date*

Please provide Individual Reference Number on Medicare Card*

Does the travelling Athlete have private health cover?*

Name of Private Health Fund*

Member Number of Private Health Fund?*

Does the travelling Athlete have ambulance cover?*

Please list off any known allergies or adverse reactions to medications or substances?*

Please list off any medical conditions we should be aware of?*

Please list off early warning signs for medical conditions/allergies?*

Is the athlete currently taking any medication?*

Please outline name, dose and purpose of medication?*

Are there any re-occurring injuries we need to be aware of?*

Please provide the athlete's swimming ability?*

Do you give permission for your Athlete to take Paracetamol (e.g. Panadol)*

Do you give permission for your Athlete to take Ibuprofen?*

Do you give permission for basic first aid, including the cleaning and dressing of minor wounds?*

Has your athlete travelled and stayed independently without family previously?*

Please let us know how your child likes to wind down? E.g. reading, quiet space, board games, music etc.*

Are there any other concerns, needs or information you would like the off-field team to know about? E.g. Sleeping habits, travel anxiety, sensory issues, religious practices, dietary requirements etc.?*

I confirm that the information provided is true and complete to the best of my knowledge*

Yes