TEAM ATHLETICS SVG MEDICAL APPEALS FORM
I ________________________________ hereby appeal my non-selection to a Team
Athletics national representative team for the _____________________________
Games/Competition on Medical grounds.
Athlete’s name ___________________________ Date: ___________________
Date of onset of injuries/illness __________________________________
Required Support Documentation
A medical doctor’s diagnosis of the injury or illness. This should also include a written prognosis for the athlete’s return to competition readiness by the competition dates.
A rehabilitation and training plan for the estimated period of time until the athlete is able to return to competition readiness. It should be designed to minimize risk to the athlete’s personal health but ensures optimal return to full training and competition at the earliest possible date.
Signature of Athlete ___________________________ Date_________________
Signature of Parent/Guardian ___________________________ Date ________________
(if Athlete is under 18 years)
Medical Practitioner’s Signature ________________________ Date ________________