UCAC Registration Form
Full Year
Please take your time, some sections are mandatory.
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
*
Female
Male
Coaches (choose all that applies)
*
Dale Schoenthaler
Ricardo Greenidge
Duncan Margach
Doug Lamont
Steve Adams
Les Gramantik
Kristian Watson
James Holder
Jane Kolodnicki
Jess O'Connell
Colton Quinn
Other
Athletics Alberta Number
Canadian Citizen
*
Yes
No
Alberta Healthcare Number
Any medical illnesses such as diabetes, asthma (exercise asthma), kidney problems, etc. or Allergies?
*
Yes
No
List Illnesses, Allergies and Medications
Physician Name
First Name
Last Name
Physician Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian or Emergency Contact
One is required
Parent/Guardian Emergency Contact Name
*
First Name
Last Name
Parent/Guardian Emergency Contact Email
*
example@example.com
Parent/Guardian Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Emergency Contact Name
First Name
Last Name
Parent/Guardian Emergency Contact Email
example@example.com
Parent/Guardian Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
UCAC MEDIA RELEASE
I, the undersigned, do hereby consent and agree to the University of Calgary Athletics Club (UCAC) members and its coaches, and/or volunteers having the right to take photographs, videotape, or digital recordings of myself or of my son/daughter and to use these in any and all media, now or hereafter known, exclusively for the purposes of UCAC. I further consent that I the athlete or my son/daughter’s name and identity may be revealed therein or by descriptive text or commentary.I do hereby release to UCAC, its agents, and volunteers all rights to exhibit this work in print and electronic form publicly or privately for internal purposes and marketing purposes. UCAC agrees to not sell individual photos and images for resale outside of the club.I represent that I am the athlete or the parent of the athlete/s named and have read and understand the foregoing statement, and am competent to execute this agreement.
UCAC Media Release
*
Agree
Disagree
UCAC CONDITIONS OF MEMBERSHIPS
I agree to abide by: The regulations of Athletics Alberta, Athletics Canada, and the UCAC Volunteering requirements found at Membership Info - University of Calgary Athletics Club (uofcathletics.ca). I understand the sport of Track and Field involves certain inherent risks. I assume that all safety precautions are taken and in consideration of your accepting my child/myself I hereby, for myself, my heirs, executors, administrators and assigns, waive and release any and all rights and claims for damage I have against the University of Calgary Athletics Club, persons holding and sponsoring this Club, their agents, representatives, successors and assigns for any and all injuries and losses suffered by me and mine with said Club. In addition, the University of Calgary Athletics Club has my permission to render any necessary first aid emergency treatment to my child/myself while in attendance with the Club. In case of a serious accident the University of Calgary Athletics Club will automatically call an ambulance.
UCAC Conditions of Memberships
*
Agree
Disagree
CANADIAN ANTI-DOPING PROGRAM (CADP)
Athletics Canada has adopted the 2021 Canadian Anti-Doping Program (CADP), which is the set of rules that govern doping control in Canada. Administered by the Canadian Centre for Ethics in Sport (CCES), the CADP applies to members of Athletics Canada and participants in Athletics Canada sanctioned activities. All members of Athletics Canada, whether in the role of athletes or athlete support personnel, are subject to the CADP. By agreeing below, I acknowledge that I as a member of Athletics Alberta/Athletics Canada I am aware that the CADP applies to me and I consent to its application to me.
Canadian Anti-Doping Program
*
Agree
Disagree
I, the athlete, agree with the following statements:
*
I am physically able to take part in the activities.
I know there is a risk of injury. I understand the risk of continuing to play sports with or after a concussion or other injury. I may have to get medical care if I have a suspected concussion or other injury. I also may have to wait 7 days or more and get permission from a doctor before I start playing sports again.
FEES AND PAYMENT OPTIONS
Membership Fees and Payment Options
*
Full Payment $1550
Installments $550 October 1st, $500 April 1st, $500 June 1st
Other as approved by the Board
Any money owning from 2023-24? All past fees must be paid or arrangement made.
*
No
Yes (remit to registrar@uofcathletics.ca)
Not sure (contact registrar@uofcathletics.ca)
Payment Methods
E-Transfer (preferred) or Credit Card, please note paying by Credit Card does not submit this form, you still have to submit this form.
Choose Payment Option
*
1. By E-Transfer - Preferred Method
2. By Credit Card (see links below)
3. Using personal account credits, then click on submit
4. Other as approved by the Board, then click on submit
1. E-TRANSFER send payment to registrar@uofcathletics.ca
PREFERRED METHOD OF PAYMENT - Pay full amount $1550, or first installment $550. NOTE: second installment $500 due on April 1st, third installment $500 due June 1st.
OR
2. CREDIT CARD (Helcim), make sure to come back and submit the form after your payment.
See links below, choose 1. to pay full amount or 2. to pay first installment
1. Full Year Payment - $1550
2. First Installment - $550
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: