Player Information

Identification Type *
Birth CertificatePassportSouth Africa ID DocumentOther

First Name *

Second Name

Surname *

Date of Birth (dd/mm/yyyy) *

Current School
Choose Current School Harrismith High Curro Salt Rock Pionier Pongola Akademie Gelofte Skool Kingsway High Kuswag Skool George Campbell Hillcrest High Amanzimtoti High Clifton School DHS (Durban High School) Glenwood High School Kearsney College Northwood School Pinetown Boys' High School Westville Boys' High School

Grade *
Choose123456789101112

Gender
ChooseFemaleMale

Race
ChooseBlackColouredIndianWhite

Contact Number *

Email *

Physical Address

Upload Photo (JPG, PNG, or PDF only, max 5MB): *

Upload Scanned Copy of your ID (JPG, PNG, or PDF only, max 5MB): *

Parent/Guardian Information

Primary Parent

Primary Parent - Name *

Primary Parent - Contact Number *

Primary Parent - Email *

Primary Parent - Relation? *
ChooseMotherFatherGuardianOther

Secondary Parent

Secondary Parent - Name

Secondary Parent - Contact Number

Secondary Parent - Email

Secondary Parent - Relation?
ChooseMotherFatherGuardianOther

Medical Information

Doctor's Name

Doctor's Contact Number

Medical Aid Name

Medical Aid Plan

Membership Number

Rugby Information

Do you register for school Rugby?

YesNo

Preferred Position
ChooseLoosehead PropTighthead PropHookerLockBlindside FlankerOpenside FlankerNumber 8Scrum-halfFly-halfLeft WingRight WingInside CentreOutside CentreFullbackSub

Highest Level Attained
ChooseClub A TeamClub B TeamDRSU U13DRSU U14DRSU U15DRSU U16DRSU U18High School 1st XVHigh School U14AHigh School U15AHigh School U16AKZN U12KZN U13KZN U16KZN U18 AcademyKZN U18 Craven Week

Coach Name *

Coach Contact Number *

BokSmart: Pre-Participation Questionnaire

Has a doctor ever restricted your sports participation?

YesNo

Do you have a medical condition (e.g., epilepsy, diabetes, asthma)?

YesNo

Do you have any allergies?

YesNo

Have you ever passed out, felt dizzy, or fainted during exercise?

YesNo

Have you ever had a heart test (ECG, Echo) due to health concerns?

YesNo

Have you ever experienced chest pain during or after exercise?

YesNo

Do you often feel fatigued or short of breath during exercise?

YesNo

Have you had flu-like symptoms, fever, or illness in the last week?

YesNo

Does your family have a history of sudden death or heart disease?

YesNo

Have you ever had a head injury or concussion?

YesNo

Have you had multiple head injuries in the past?

YesNo

Do you currently have symptoms like headaches, nausea, or dizziness?

YesNo

Have you ever experienced numbness or tingling during exercise?

YesNo

Have you ever had a seizure?

YesNo

Have you ever had a neck injury related to sports?

YesNo

Have you visited a doctor in the last 6 months for a medical issue?

YesNo

Do you require a BokSmart clearance?

YesNo

I agree and understand the above? *