HOCKEY REGISTRATION 2019-20

OUTLOOK MINOR SPORTS

2019-20 Hockey Registration

OPEN MAY 1 - 31, 2019
Athlete Information
Player Name

First NameMiddle NameLast Name
Birthdate
Sask. Health Card Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 1

First NameLast Name
Parent 2

First NameLast Name
Rural Land Location
Home Phone

Area CodePhone Number
Parent 1 Cell Phone

Area CodePhone Number
Parent 2 Cell Phone

Area CodePhone Number
E-mail
example@example.com
DIVISION CATEGORIES
Emergency Contact
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
I have read and agree to the above conditions

OMS MEDICAL FORM
CHECK THE APPROPRIATE RESPONSE PERTAINING TO YOUR CHILD:

Other
MEDICATIONS:
ALLERGIES:
MEDICAL CONDITIONS:
RECENT INJURIES:
LAST TETANUS SHOT:
DATE OF LAST MEDICAL EXAM:
ADDITIONAL INFORMATION:
I understand that it is my responsibility to keep the team management informed of any change in the above information as soon as possible and that in the event no one can be contacted; team management will take my child to a hospital or doctor if deemed necessary.
I hereby authorize the doctor and nursing staff to undertake the examination, investigation and necessarytreatment of my child.
Type your childs name
I also authorize release of information to appropriate people (coach, doctor) as deemed necessary.
Parents Signature
Type your name as your signature.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: