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2022 Windsor Stars Player Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* Province:

* Postal Code:

* Home Phone:

* Birthdate:

* Email:

* Gender:

* Team:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Phone Number:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Phone Number:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone Number:

* Relationship to Player:

* Health Card #:

Please select the appropriate response below

* Epileptic:

* Wears dental appliance:

* Previous History of Concussions:

* Asthma:

* Trouble Breathing During Exercise:

* Wears Glasses/Contact Lens:

* Diabetic:

* Allergies:

* Wears Medical Alert Bracelet or Necklace:

* Any Health problems that would interfere with participation on this team:

* Allergy that would require the use of an Epi-Pen:

* Heart Condition:

Please give details below if you answered "YES" to any of the items above

Medications:

Recent Injuries:

* Date form filled out:

* Form Filled out by:

WAIVER INFORMATION

*** Insert your waiver information here ***

I/we agree with the above *

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* indicates required fields

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2022 Windsor Stars Player Registration Form