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Athlete Information

Prénom *

Nom *

Sexe *

Homme Femme

Date de naissance (AAAA *-MM-JJ)

/ /

Lieu de résidence *

Birth Country *

Citizenship *

Parent/Guardian Information

First Name *

Last Name *

Phone Number * - Téléphone international

Email * Recevoir des courriels

Emergency Contact Information

First Name *

Last Name *

Phone Number * - Téléphone international

Email * Recevoir des courriels

Relationship to Athlete *

Athlete Medical Information

ALLERGIES

Does your child/ward have any FOOD allergies? If so, please describe below. (Ex. Peanuts - Reaction: Wheezing - Uses EpiPen - Anaphylactic) *

Does your child/ward have any NON-FOOD allergies? If so, please describe below. (Ex. Pollen - Reaction: Stuffy Nose - Takes Reactin) *

MEDICAL CONDITIONS

Please list any current or past medical conditions (ie. heart and lung conditions, diabetes, epilepsy, ADHD/ADD). Please include any pertinent details: *

INJURIES

Please list any current injuries you may have, or any injuries that have occurred within the last year. Please include any pertinent details: *

MEDICATION

List all current prescribed medication- all formats (pills, patches, injections, inhalers, etc.). (Ex. Naproxen 500mg two times daily for osteoarthritis since March 2025) *

Are you regularly using over-the-counter medications (i.e- anti-reflux, anti-inflammatory, allergy, etc. )? *

Event Area

Event Area *

Performance de classement

: : .

Lieu de performance de classement

Date de performance de classement

Ajouter un autre event area

Les éléments de renonciation sont requis pour cette inscription. Veuillez inscrire l’adresse courriel de l’inscrit ou du parent/tuteur (si l’inscrit est d’âge mineur).

Adresse courriel où envoyer la renonciation *

C.A.N.I Athletics Junior Stars 2026-2027

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