🏉 East Transvaal Rugby

Player Registration

Step 1 of 5

Player & Parent Details

Please select an age group
PLAYER
First name is required
Last name is required
FATHER
Father's mobile number is required
MOTHER
MEDICAL AID
FAMILY DOCTOR
EMERGENCY CONTACTS

BokSmart Medical Questions

This questionnaire helps us ensure that your child can safely participate in rugby activities. Please answer all questions honestly.
PLAYER PROFILE
MEDICAL QUESTIONS
1. Have you ever been told by a doctor not to participate in sport?
2. Do you have a medical condition for which you take daily medication? (e.g. asthma, diabetes, high blood pressure, epilepsy, ADHD)
3. Do you have any allergies? (e.g. bees, grass, pollen or medication)
4. Have you ever fainted or nearly fainted during exercise?
5. Has a doctor ever ordered a test for your heart? (e.g. ECG, scan)
6. Have you ever experienced chest pain or severe breathing problems during exercise?
7. Do you get tired much faster than your friends during exercise?
8. Have you had a flu-like illness in the past 4 weeks? (Covid-19, cold, gastroenteritis)
9. Has a family member ever died suddenly and unexpectedly?
10. Have you sustained a head injury this season?
11. Have you had three or more head injuries or concussions in your life?
12. Have you ever experienced headaches, dizziness, memory loss, or confusion after a blow to the head?
13. Do you suffer from headaches, numbness, or "pins and needles" during exercise?
14. Have you ever had a seizure (fit)?
15. Have you ever seriously injured your neck?
16. Is there anything you would like to see a doctor about?
CLEARANCE

Indemnity Declaration

I, as parent/guardian, grant permission for my child to participate in the following sports activities:

I indemnify BCVO, Sports Council, the School or Organizers, stadium and municipality representatives from any damage or event that may arise as a result of my child(ren)'s participation.

I accept that all reasonable precautions will be taken for the safety and well-being of my child/children and I accept responsibility for payment of medical bills and/or hospital bills, if applicable, in case of illness or injury.

I transfer my powers as parent/guardian to the Organizers or their authorized representative should medical treatment for the child be necessary.

Signature is required
You must agree to the indemnity declaration to continue

Upload Documents

📄
Click to upload birth certificate
Birth certificate is required
💳
Click to upload medical aid card
Medical aid card is required
🪪
Click to upload main member ID
Main member ID is required
📸
Click to upload photo of child
Photo of child is required

Confirmation & Submit

Please verify that all information is correct before submitting.

✅

Thank You!