Before your first session

Health Questionnaire.

Pippa needs this before the first session so she can coach safely and act quickly if anything happens. It takes about three minutes. If the athlete is under 18, a parent or guardian should fill it in.

Athlete

Athlete's full nameDate of birth

Who is filling this in?

Contact

PhoneEmail

Who should Pippa call if she cannot reach you during a session?

Emergency contactRelationshipTheir phone

Second contact (optional)Their phone

Medical

If none apply, write "none" — it tells Pippa you have read the question rather than skipped it.

Medical conditionsAsthma, epilepsy, diabetes, heart conditions, joint or bone problems, anything ongoing.

MedicationAnything taken regularly.AllergiesFood, insect stings, medicines.

Does the athlete carry an inhaler, EpiPen or other emergency medication?InjuriesCurrent or recent, and anything that still limits training.GP name and surgery (optional)Anything else Pippa should know

I confirm this is accurate, and I consent to Pippa Earley holding this information to coach safely and to act in an emergency. I can withdraw consent at any time by emailing her, and this will be deleted. See the privacy notice.If I cannot be reached, I consent to the athlete receiving emergency medical treatment on my behalf.

Health Questionnaire.

Athlete

Contact

Medical

Consent