TRACKIE - Online registration for events, tournaments, clubs and organizations...

Êtes-vous un nouveau membre ou un membre de retour? *

Prénom *

Nom *

Sexe *

Homme Femme

Date de naissance * (AAAA-MM-JJ)

/ /

Équipe - Le vôtre manque ?

Club Instructor's Name *

Club Instructor's Email - Important to use the correct coaches email so that they receive all the BC Team information. *

Additional Coach's Name (optional)

Additional Coach's Email Address Recevoir des courriels

Zone *

Athlete's Street Address *

City *

Postal Code *

Phone Number * - Téléphone international

Contact Email for Athlete (Please ensure this email is correct as all BC Team & Karate Canada correspondence will go to this email and will be deemed to have been received if sent to this email). DO NOT USE your coaches email address in this field. * Recevoir des courriels

BC Care Card Number *

Photo (headshot) *

Parent/Guardian's First Name *

Parent/Guardian's Last Name *

Parent/Guardian's Email *

Emergency Contact Name *

Emergency Contact Relationship to Athlete *

Emergency Contact Phone * - Téléphone international

Additional Email #1

Additional Email #2

I am a *

Year 1 Goals *

Year 2 Goals *

Year 3 Goals *

My technical strengths: *

My technical weaknesses: *

My tactical strengths: *

My tactical weaknesses: *

My physical strengths: *

My physical weaknesses: *

Psychology *

Nutrition *

Please list any injuries including concussions in the last 6 months that the coaching staff should be aware of? *

BC Medical Service Plan (MSP) Number *

1. Are you medically fit enough to compete in a karate competition? *

2. Do you have any joint injuries still healing? *

3. Do you have any allergies or anaphylactic reaction? *

4. Have you had a head injury (concussion) within the last 6 months? *

a. If yes, what was the date you were officially by a medical doctor cleared to return to compete in karate competitions?

b. Are you still currently suffering from any symptoms?

c. Are you back to training at the same competition ability level as before your concussion?

5. List any medications

6. List any fractures, orthopedic surgery, disease or disability that the tournament medical staff need to know before you compete in this karate tournament:

Confirm Name of Competitor *

Confirm Name of Parent/Guardian (if competitor is under 19 years of age)

Do you consent to KBC sharing you contact information with CSI Pacific if you are recommended for carding? *

Yes No

Division

Division *

Catégorie *

Ajouter un autre division

J’ai lu et accepte les conditions *
Consent Waiver

J’ai lu et accepte les conditions *
Athlete Agreements and Code of Conduct

Signature numérique (doit correspondre exactement au « registrants name ») *

2027 U21 & Senior Prospect Registration - Jan Nationals

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