Alberta Provincial Championships (APC) - 2025

Player Registration and Health Form

Part 1:

The pupose of this form is to advise emergency personnel of any pre-existing medical conditions, personal histories, or vital care information, should the need for emergency care be required and you are unable to communicate the information.

Applicant's Name *

Email address *

Telephone *

Home Address *

City *

Province *

Team *

Medical Card Number *

Date of Birth (yyyy-mm-dd) *

Pre-existing medical conditions *

Personal Care *

Vital Care information *

Prescribed Medications *

Allergies *

Emergency Contact Person *

Contact Person's Phone number *

Relationship to Applicant *

Acknowledgement *

By submission of this form, I acknowledge that the information in this form is accurate, and I am aware that anyone submitting misleading or false documentation may be subject to disciplinary action, which could result in a suspension from this or future tournaments.

Authorized use of information in this form *

I authorize the use of the information contained in this form for use in an emergency by appropriate personnel.

Destruction of the information contained in this form. *

I authorized the destruction of this form by the Organization Committee at the end of this tournament.

Notify Team Manager *

I undertake to inform my team manager that I have completed this form as required by the Tournament Committee.