GENERAL INFORMATION
Registration Date: ___________________________________
(Father) Last Name: ___________________First Name:___________________
(Mother) Last Name: ___________________First Name:___________________
Mailing Address: _________________________________________________
City: _______________ Province: _________ Postal Code: ________
Home Phone: __________
Alternate Phone 1: __________________Alternate Phone 2:_________________
Email: _________________________________________________________
Please provide as this is primary method of relaying information to club members.
Family Doctor: ______________________Health Care # ___________________
Please provide details of any allergies, medical conditions, or previous injury, which should be provided to medical professionals in the case of accident or illness:
_______________________________________________________________
Emergency Contact: In case parents are unavailable, please contact:
Name: ___________________________Phone Number: ___________________
ATHLETE REGISTRATION
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Athlete's Name |
Program |
Gender F / M |
AGE (as of Dec 31, 2011) |
Birth Date (MM/DD/YY) |
Fee |
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1 |
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2 |
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3 |
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4 |
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TOTAL FEE: |
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Note: Program Fees do not include BC Alpine Registration fees.
