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Emergency Contact Form
This is an Emergency Contact Form. The information here will remain confidential and only be used in the case of an emergency. Please fill out for each athlete. If any of the information changes, please let us know so we can update our files.
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* Indicates required question
Athlete's Full Legal Name
*
Your answer
Athlete's Alberta Health Care Number
*
Your answer
Athlete's Home Address
*
Your answer
Athlete's Date of Birth (DD/MM/YYYY)
*
Your answer
Emergency Contact 1 Full Name
*
Your answer
Emergency Contact 1 Phone Number
*
Your answer
Emergency Contact 1 Email Address
*
Your answer
Emergency Contact 1 Relation to Athlete
*
Your answer
Emergency Contact 2 Full Name
Your answer
Emergency Contact 2 Phone Number
Your answer
Emergency Contact 2 Email Address
Your answer
Emergency Contact 2 Relation to Athlete
Your answer
Are there any past injuries that we should be aware of?
Your answer
Are there any allergies that we should be aware of?
Your answer
If Yes, does the athlete require an Epi Pen?
Your answer
Is the athlete on any medications?
Your answer
Is there anything else that the coaching staff should be aware of?
Your answer
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