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MCHS Athlete Medical Information
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Last name
Your answer
First Name
Your answer
Team
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Sr. Boys Basketball
Sr. Girls Basketball
Jr. Boys Basketball
Jr. Girls Basketball
Badminton
Sr. Boys Soccer
Sr. Girls Soccer
Sr. Boys Rugby
Sr. Girls Rugby
Track & Field
Wrestling
Sr. Boys Volleyball
Sr. Girls Volleyball
Jr. Boys Volleyball
Jr. Girls Volleyball
Swimming
X-Country
Flag Football
Date Birth
MM
/
DD
/
YYYY
Grade
10
11
12
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Parent/Guardian #1 Last Name, First Name
Your answer
Parent/Guardian # 1 Phone Number
Your answer
Parent/Guardian #2 Last Name, First Name
Your answer
Parent/Guardian # 2 Phone Number
Your answer
Primary Address
Your answer
Alberta Health Care #
Your answer
Does your child have any physical, emotional, behavioral or mental health needs we should be aware off?
Your answer
Does your Child have any allergies we should know of? How should this be managed?
Your answer
Has your athlete ever suffered from a concussion?
Choose
Yes
No
If yes, how many?
Your answer
When was the last concussion?
Your answer
Who cleared your athlete for play?
Your answer
Are there any other limitations on your athlete we should know about it?
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