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CMHA Medical Form
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* Indicates required question
Email
*
Your email
Player Name (Full)
*
Your answer
Address (Full)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Phone Number (numbers only)
*
Your answer
Team
U7
U9 Blue
U9 Gold
U9 White
U11 CAHL A
U11 CAHL B
U11 RHL A
U11 RHL B
U13 CAHL A
U13 CAHL B
U13 RHL A
U13 RHL B
U15 CAHL A
U15 CAHL B
U15 RHL A
U18 CAHL A
U18 FEMALE A
U18 RHL A
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Health Care Number (numbers only)
*
Your answer
Emergency Contact (please include name, relationship to player and phone number)
*
Your answer
Family Doctor (Name and Phone Number)
*
Your answer
Date of player's last physical (month/year)
*
Your answer
How many years has your player been involved in organized sport?
*
Your answer
Year of participation in hockey
*
Your answer
What position will you be playing this year?
*
Forward
Defense
Goalie
N/A
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