GOLDEN HORSESHOE DISABLED SPORTS ASSOCIATION REGISTRATION FORM 2021/2022

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ATHLETE

NAME:		DATE OF BIRTH:	yyyy-mm-dd
CONTACT INFORMATION
ADDRESS:
CITY:		POSTAL CODE:
PHONE:		EMAIL:
ATHLETE'S DISABILITY:
ALLERGIES:

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PARENT(S)/GUARDIAN(S)

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

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EMERGENCY CONTANCT

NAME:
PHONE:

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DOCTOR

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