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Prénom *

Nom *

Sexe *

Homme Femme

Date de naissance (AAAA *-MM-JJ)

/ /

Adresse postale - Adresse *

Adresse 2

Ville *

Province / État *

Pays *

Code postal *

Adresse e-mail * Recevoir des courriels

Athlete with a Disability (Para)? *

Emergency Contact (Full Name) *

Emergency Contact (Relation to Athlete) *

Emergency Contact (mobile phone) * - Téléphone international

Emergency Contact (Email) *

Provincial Medical Insurance Number *

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 "None" if the athlete is not currently on any medications. *

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 "None" if there are no injuries. *

CHRONIC CONDITIONS: Please list any chronic conditions that club staff should be made aware of (ie: Diabetes, Epilepsy, Heart conditions, etc.). This information will remain confidential between athlete and coach. Enter "None" if there are no conditions to note. *

Phone Number * - Téléphone international

2024 Kajaks TFC (9-13 years) Cross Country Seasonal Membership

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Type d’adhésion