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Medical Questionnaire

Please fill out the following form to help us understand your physical condition.

Has the student been hospitalized in the last 12 months?

No

Yes

Is the student currently suffering from a medical condition, illness, or injury including allergies?

No

Yes

If you answered yes to any question, please elaborate

Is the student deemed healthy to perform elite and demanding athletic activities?

No

Yes

Name of parent or legal guardian

I declare that the info I’ve provided is accurate & complete

I hereby understand and agree that Ribeiro Moojen Pre-University soccer or any other organization affiliated to will not be help responsible for injury related or unrelated to sports activity.

I hereby agree to sign this document electonically.

Your Signature

Thanks for submitting!

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