SDFA adventurer club 2025-2026
Staff contact information
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Select preferred method of communication:
*
Text messages
Emails
Both text and email
Primary care doctor and phone number
*
Medical insurance and plan number
*
Medication allergies
*
No known drug/medicarion allergies
Yes, I have a medication allergy
Food allergies or dietary restrictions
*
No known food allergies
Yes, I have a dietary restriction (ie: vegetarian, vegan)
Yes, I have a food allergy
If you answered yes for medication or food allergies, dietary restrictions, please list below along with explanation (ie: vegetarian, amoxicillin causes rash)
*
Please list any prescription medications and what it is prescribed for. Please include medication strength and frequency
*
Emergency contact
*
Name
Relationship
Emergency Contact Phone Number
*
Please indicate if registration payment was submitted
*
Yes
No
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