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Member Information

Are you a new or renewing member?

First Name *

Last Name *

Gender *

Male Female

Date of Birth (YYYY *-MM-DD)

/ /

Citizenship *

Birth Country *

Parent/Guardian

Parent/Guardian Email Opt in to emails

Contact Information

Full Mailing Address - Street Address *

Address 2

City *

Province/State *

Country *

Postal Code *

Individual Email * Opt in to emails

Phone * - International Number

Other Information

Preferred pronouns

Preferred name (if different from given name) *

Athlete's primary interest *

Primary Contact Name(s) *

Primary Contact Email *

Primary Contact Home Phone *

Primary Contact Cell Phone *

Primary Contact Address *

Primary Contact City *

Primary Contact Postal Code *

Alternate Emergency Contact Name *

Alternate Emergency Contact Phone *

Alternate Emergency Contact Address *

Doctor's Name *

Doctor's Telephone # *

Date of last physical examination *

Previous history of concussions *

Fainting episodes during exercise *

Epileptic *

wears glasses *

wears contact lenses *

wears dental appliance *

hearing problem *

asthma *

trouble breathing during exercise *

heart condition *

diabetic *

medication *

allergies *

wears a medic alert bracelet or necklace *

If wears a medic alert bracelet or necklace, for what purpose? *

PLease give details if you answered yes to any of the above questions *

recent injuries *

any information not covered above *

I hereby grant the Riversdale Athletics Club use of my and/or my son’s/daughter’s photo image, in good taste, for the purpose of Club promotional photos, the club end of season DVD montage and club website and social media accounts. I release the Riversdale Athletics Club of all liability of any nature in their use of photo/digital images for the above mentioned purposes. *

Digital Signature of Parent/Guardian *

Where did you hear about Riversdale?

Membership type

Membership type *

Category *

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Additional Items

Riversdale Nike competition singlet

$68.00

QTY

Waivers

I have read and agree *
Saskatchewan Athletics Photo Release

I have read and agree *
Saskatchewan Athletics Dispute Resolution Policy & Privacy Policy & Code of Conduct

I have read and agree *
Canadian Anti-Doping Program (CADP)

I have read and agree *
Riversdale Athletics Club - CODE of CONDUCT