KNOX CITY COUGARS MEDICAL CERTIFICATE SUBMISSION FORM

Knox City Cougars will apply for game credit for qualification for finals for players who are going to miss one or more games due to injury or illness and can provide a medical certificate.

Medical certificates must be submitted within 14 days of date on certificate/date of injury. We cannot submit backdated certificates.

Any queries can be submitted to medicals@knoxcitybasketball.com.au

Even if you do not need to gain game qualification credit, please submit medicals, as it also means the team may be able to source replacement players if short.

No player is allowed to train or play whilst restricted with a medical certificate, and any return to play during the period stated on the Medical certificate OR if the medical certificate has no end date, will require a new certificate stating the player is fit to play.

Please note - submitting medical certificates to Knox Raiders WILL NOT cover domestic games.

If players are found to be playing whilst on a medical certificate, THE TEAM will receive forfeits for games played.

PLAYER NAME *

First NameLast Name

AGE GROUP*

GIRLSBOYS

TEAM (e.g. U 12/1)*

GRADE (e.g. E grade)*

MEDICAL DOCUMENTS *

START DATE OF MEDICAL *

Date

DOES THIS MEDICAL HAVE AN END DATE*

YESNO

MEDICAL END DATE (if applicable)

Date

Do you understand that if there is no end date you will be required to submit a clearance to return to play?

YESNO

OTHER DETAILS :

PARENT NAME:*

PARENT EMAIL ADDRESS:*