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Contact Information

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Phone * - International Number

Other Information

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Emergency Contact (Full Name) *

Emergency Contact (Relation to Athlete) *

Emergency Contact (Mobile Phone) * - International Number

Emergency Contact (Other Phone) * - International Number

Emergency Contact (Email) *

Family Doctor (Name) *

Family Doctor (Phone) * - International Number

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MEDICATIONS: Please (a) list any medications that club staff should be made aware of and (b) the reason for said medications. This information will remain confidential between coach and athlete. Enter *

INJURIES: Please list any injuries that club staff should be aware of. Please also indicate the date of any recent injuries. This information will remain confidential between coach and athlete. Enter *

CHRONIC CONDITIONS: Please list any chronic condistions that club staff should be aware of (i.e. Diabetes, Epilipsy, Heart Conditions etc.). This information will remain confidential between coach and athlete. Enter *

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(CHECK ONLY IF YOU AGREE) Photograph and Name Usage Release Waiver

2025 Kajaks TFC Track Rascals - February Indoor

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