GOLDEN HORSESHOE DISABLED SPORTS ASSOCIATION REGISTRATION FORM 2023/2024

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:

EQUIPMENT LOAN

GHDSA agrees to loan equipment listed below (describe and record all equipment)

I take full responsibility for the care and safe storage of the above equipment on loan and will report any damage or breakage to the Board of Directors immediately. Any time you receive or borrow equipment this document should be updated.

If an athlete is no longer in good standing or does not participate in GHDSA's programs(s), all loaned equipment must be returned to GHDSA at once. The Board reserves the right to assign a fee for any lost or damaged equipment, uniforms or materials. No Equipment may be released without proper documentation. The board reserves the right to recall any equipment.

Name of Athlete/Guardian:
Date:

I confirm that the athlete and parent(s) / guardian(s) (if applicable) have read and agree to abide by the applicable code(s) of conduct as detailed on https://www.vipersbasketball.ca