MEDICAL DECLARATION
	Paddler Full Name					ID:
	Club Name:					Zone / State:
	Generic name of medication and dosage (RN):
	Method of administration:
	Indications for use:
	Prescribing Physician:
	Medical council registration Number:					Phone:
	E-mail :					Fax :
	Physician’s Address:
	Physician Signature:					Date :
	Paddler’s consent to provide a copy of this medical declaration to the Australian Sports Drug Agency,
	I,
	agree to  AOCRA Inc passing on this medical certificate or record thereof, provided by me for the purpose of complying with the doping control regulations of AOCRA INC. as are current and for that purpose only :
	Paddler Signature:					Date :
	Parent / Guardian Signature: (if paddler under 18 years)					Date :