World Games - Men's Team Canada Medical Information

Name

Player's Cell Phone

Emergency Contact Person

Name

Email of Emergency Contact

Relationship to Emergency Contact Person

Emergency Contact's Phone Number

List any allergies (medications or food) or dietary needs you have.

List an injuries or conditions (past or present) we should be made aware of.

Covid Vaccination - Please click on one of the following;

I am fully vaccinated. I am partially vaccinated. I am not vaccinated.

Allow Canada Inline Staff and the host organization of any roller sports sanctioned event to provide, through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services if warranted and as needed in the course of my participation.
I am fully aware of and appreciate the risks (including the risk of catastrophic injury) associated with participation in competitive roller skating events. I further agree that Canada Inline, the host organization and the sponsors of Canada Inline shall not be liable for any losses or damages occurring as a result of my participation in any event of this sport. As a member of Team Canada, I agree to submit to the authority and acknowledge the responsibilities of the Team Coach, Team Leader, Team General Manager or Team Doctor/Medical Representative in matters that pertain to training for and the conduct of the Team’s participation in these international championships. This agreement shall remain effective as long as I am a member in good standing of the Canadian World Championships Team.

Signature of Participant

I agree to the above terms and acknowledge that the information provide is as accurate as possible.

Discount

Subtotal

Tax

Total USD