GOLDEN HORSESHOE DISABLED SPORTS ASSOCIATION REGISTRATION FORM 2017/2018
ATHLETE
NAME: DATE OF BIRTH: yyyy-mm-dd

CONTACT INFORMATION
ADDRESS:
CITY: POSTAL CODE:
PHONE: EMAIL:
ATHLETE'S DISABILITY:
ALLERGIES:

PARENT(S)/GUARDIAN(S)
NAME(S):

CONTACT INFORMATION (if different from athlete)
ADDRESS:
CITY: POSTAL CODE:
PHONE: EMAIL:

EMERGENCY CONTANCT
NAME:
PHONE:

DOCTOR
NAME:
ADDRESS:
PHONE:
If medication or treatment is required during programs, please give details: