1. I declare that the information regarding my present state of health and that given to the examining physician is correct.
2. I undertake not to use any substance included on the World Anti-Doping Agency list of prohibited substances and methods.
3. I undertake to advise the CACC without delay of any significant change in my state of health.
4. I agree to be re-examined upon the expiration of my current medical as required by the current competition rules or following any significant illness, injury or hospitalization.
5. I give permission to any hospital, institution, or physician, to furnish my medical information to CACC.
6. I consent to the transmission of this document to the email address provided.
7. I consent to the storage and retention of this document by the CACC and its confidential use in official matters.
