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MASC Athlete Profile and Medical Information
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* Indicates required question
Athlete's First Name
*
Your answer
Athlete's Last Name
*
Your answer
Athlete's Preferred Name
*
Your answer
Placement (please select the day/s your athlete would be available for class)
*
Recreational - Mondays 5-6pm
Recreational - Tuesdays 5-6pm
Recreational - Saturdays 5-6 pm
Required
Birth Date
*
MM
/
DD
/
YYYY
Male/Female
*
Male
Female
Address (Number, street, city and postal code)
*
Your answer
Parent's Name
*
Your answer
Home Phone
*
Your answer
Cell Phone
*
Your answer
Email address
Your answer
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