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Prénom *

Nom *

Sexe *

Homme Femme

Date de naissance (AAAA *-MM-JJ)

/ /

Lieu de résidence *

Équipe

Athlete with a Disability (Para)? *

Emergency Contact (Full Name) *

Emergency Contact (Relation to Athlete) *

Emergency Contact (mobile phone) * - Téléphone international

Emergency Contact (Other Phone) * - Téléphone international

Emergency Contact (Email) * Recevoir des courriels

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 you are 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 condential between coach and athlete. Enter "None" if there are no injuries. *

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

VOLUNTEERING: The Kajaks Family Volunteers and all members are encouraged to get involved with club activities to support programs, athletes and coaches. Harry Jerome Indoor Games will have lots of opportunity to get involved! *

Type d’adhésion

Catégorie *

2025 KajaksTFC Junior Development (9-13) WINTER Only Membership

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Type d’adhésion