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AFL Queensland Medical, Injury and Indemnity Form
Please complete all fields, except signature sections. We will print them and get you to sign them in person.
1
Indemnity Form
2
Emergency Medical Treatment/History
3
Medical & Injury Profile Sheet
I (Name of Parent/Guardian)
AGREE to indemnify AFL Queensland and its servants or agents against any claims made or actions brought for damages arising from personal injury sustained by the participant named in the First Schedule during the period in which such participant named in the First Schedule is playing, travelling or participating as a member of the Australian Football team named in the Second Schedule.
The indemnity extends to both general and special damages including but not limited to damages for pain and suffering, past and future economics loss, damages for gratuitous assistance provided by a carer, and medical, hospital and rehabilitation expenses.
The indemnity of AFL Queensland and its servants or agents further agents further extends to any claim or action for damages brought by the participant named in the first schedule arising from the negligence and/or breach of contract and/or breach of statutory duty by AFL Queensland and its servants or agents.
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First
Last
First Schedule - Name of participant:
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First
Last
Second Schedule - Details of Program
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Please Select
U16 South Eastern Bushrangers
U14 South Eastern Bushrangers
Signed (Parent/Guardian)
Date
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DD
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MM
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YYYY
1
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3
