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Prénom *

Nom *

Sexe *

Homme Femme

Date de naissance (AAAA *-MM-JJ)

/ /

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 Address) Recevoir des courriels

Medical Insurance Number *

MEDICATIONS: Please (a) list any medications that club staff should be aware of, and (b) indicate the reason for each medication. This information will remain confidential between the coach and the athlete. Enter "None" if you are not currently taking any medications. *

INJURIES: Please list any injuries that club staff should be aware of, and include the date of any recent injuries. This information will remain confidential between the coach and the athlete. Enter "None" if there are no injuries. *

CHRONIC CONDITIONS: Please list any chronic conditions that club staff should be aware of (e.g., diabetes, epilepsy, heart conditions, etc.). This information will remain confidential between the coach and the athlete. Enter "None" if there are no conditions. *

J’ai lu et accepte les conditions *
Kajaks Track & Field Club Waiver

J’ai lu et accepte les conditions *
BC Athletics Privacy Policy

J’ai lu et accepte les conditions
Photograph and Name Usage Release Waiver

2026–2027 Annual Cross Country and Distance AD Membership (14+)

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Type d’adhésion