French Sports Code
In forceQUESTIONNAIRE RELATING TO THE STATE OF HEALTH OF A MINOR SPORTSPERSON WITH A VIEW TO OBTAINING OR RENEWING A SPORTS FEDERATION LICENCE OR ENTERING A SPORTS COMPETITION AUTHORISED BY A DELEGATED FEDERATION OR ORGANISED BY AN APPROVED FEDERATION, EXCLUDING DISCIPLINES WITH SPECIAL CONSTRAINTS
Warning for parents or guardians: This questionnaire should preferably be completed by your child, as it is up to you to decide at what age your child is able to complete it. It is your responsibility to ensure that the questionnaire is completed correctly and to follow the instructions based on the answers given. |
Sport: it's recommended for everyone. Have you spoken to a doctor about this? Did he or she examine you to advise you? This questionnaire is not a check-up. You answer YES or NO, but there are no right or wrong answers. You can look at your health record and ask your parents to help you. | ||
|---|---|---|
You are a girl □ A boy □ | Your age: □ □ years old | |
Since last year | YES | NO |
Have you been in hospital for a whole day or several days? | □ | □ |
Were you operated on? | □ | □ |
Did you grow much more than in other years? | □ | □ |
Have you lost weight or put on weight a lot? | □ | □ |
Have you been dizzy during exertion? | □ | □ |
Did you lose consciousness or fall without remembering what had happened? | □ | □ |
Did you receive one or more violent shocks that forced you to interrupt a sports session for a while? | □ | □ |
Did you find it much harder to breathe during an effort than usual? | □ | □ |
Did you have a lot of trouble breathing after an effort? | □ | □ |
Did you have pain in your chest or palpitations (your heart beating very fast)? | □ | □ |
Did you start taking a new medicine every day for a long time? | □ | □ |
Have you stopped sport because of a health problem for a month or more? | □ | □ |
For some time (more than 2 weeks) | ||
Do you feel very tired? | □ | □ |
Do you find it difficult to fall asleep or do you wake up often in the night? | □ | □ |
Do you feel less hungry? Do you eat less? | □ | □ |
Do you feel sad or worried? | □ | □ |
Do you cry more often? | □ | □ |
Do you feel any pain or lack of strength because of an injury you've had this year? | □ | □ |
Today | ||
Do you sometimes think about stopping or changing your sport? | □ | □ |
Do you think you need to see your doctor to continue sport? | □ | □ |
Is there anything else you would like to point out about your health? | □ | □ |
Questions to be completed by your parents | ||
Has anyone in your close family had a serious heart or brain condition, or died suddenly before the age of 50? | □ | □ |
Are you worried about his or her weight? Do you find he is eating too much or too little? | □ | □ |
Have you missed the health check-up scheduled for your child's age at the doctor's? (This health check-up is scheduled at ages 2, 3, 4, 5, between 8 and 9, between 11 and 13 and between 15 and 16). | □ | □ |
If you answered YES to one or more questions, you need to see a doctor so that he can examine you and see with you what sport is right for you. When you visit, give him this completed questionnaire. |
