Click here for Word Document version of this form

Please Note: Post December 2003 current details updated on BJA Website

Cadet Information Home Page.

British Judo Association

Player Medical Information

Name of Judo Player: _____________________           Date of Birth: ________________

BJA Liceance No:       _____________________

Health Insurance Medical Scheme Details (if any): ___________________________________

Details of Doctor:

Name:_________________________________             Practice:________________________

Address:____________________________________________________________________

Phone (h):______________________________             Postcode:_______________________

Phone (m):_____________________________              Phone (w):______________________

E-mail:_____________________________________________________________________

Details of Physiotherapist:

Name:_________________________________              Practice:________________________

Address:____________________________________________________________________

Phone (h):______________________________              Postcode:_______________________

Phone (m):_____________________________               Phone (w):______________________

E-mail:_____________________________________________________________________

List details of any chronic injury or illness that you may have:

____________________________________________________________________________

List details of any known allergies:

____________________________________________________________________________ 

List details of any long-term medication you are taking:

______________________________________________________________________________________