Medical Information Form - U13 Team 2 (Newcastle Village Minor Hockey Association)

Medical Information Form - U13 Team 2

Personal Information

Please complete information below.

Please review the name of this form above and ensure you are completing the form that is linked to your team.

This is important to ensure the information completed is directed to the correct coaching staff.

Thank you  - and best of luck this season!

Medical History

Please select the appropriate response and provide details below if you answer "Yes" to any of the questions.

Additional Details

By clicking the box below and typing your name into the open field, I acknowledge that I understand that is my responsibility to keep the team Hockey Trainer advised of any change in the above information as soon as possible. In the event of a medical emergency and that no one can be contacted, team management will arrange to take my child to the hospital or a physician if deemed necessary.

I hereby authorize the physician and nursing staff to undertake examination, investigation and necessary treatment of my child. 

I also authorize release of information to appropriate people (coach, physician) as deemed necessary.

Electronic Signatures

Disclaimer: Personal information used, disclosed, secured or retained will be held solely for the purposes for which it is collected and in accordance with the National Privacy Principles contained in the Personal Information Protection and Electronic Documents Act.