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Athlete Information

Prénom *

Nom *

Sexe *

Homme Femme

Date de naissance * (AAAA-MM-JJ)

/ /

T-Shirt Size *

Address *

Postal/Zip Code *

Province/State/Region *

Birth Country *

Citizenship *

Parent/Guardian Information

Parent/Guardian 1

First Name *

Last Name *

Phone Number * - Téléphone international

Email * Recevoir des courriels

Relationship to Athlete *

Parent/Guardian 2

First Name

Last Name

Phone Number - Téléphone international

Email Recevoir des courriels

Relationship to Athlete

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. )? *

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 Young Stars - WINTER 2027

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