GOLDEN HORSESHOE DISABLED SPORTS ASSOCIATION REGISTRATION FORM 2021/2022
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: