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    CCT Camp 2011 Reg Form

    Uploaded by

    Ray Miller
    This registration form collects confidential information including name, address, date of birth, contact details, medical history, previous sports experience, and any physical, emotional, or social conditions. Applicants must sign a waiver acknowledging the information is true and releasing the camp of any liabilities that may arise from participation. The form gathers details on family doctor, last medical check-up, any medical problems, surgeries, medications, smoking and drinking habits, recent physical activity, allergies, AD/HD diagnosis, and other conditions to ensure full enjoyment of camp activities.

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    CCT Camp 2011 Reg Form

    Uploaded by

    Ray Miller
    4 views1 page
    This registration form collects confidential information including name, address, date of birth, contact details, medical history, previous sports experience, and any physical, emotional, or social conditions. Applicants must sign a waiver acknowledging the information is true and releasing the camp of any liabilities that may arise from participation. The form gathers details on family doctor, last medical check-up, any medical problems, surgeries, medications, smoking and drinking habits, recent physical activity, allergies, AD/HD diagnosis, and other conditions to ensure full enjoyment of camp activities.

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    Original Title

    CCT Camp 2011 Reg Form[2]

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    This registration form collects confidential information including name, address, date of birth, contact details, medical history, previous sports experience, and any physical, emotional, or social conditions. Applicants must sign a waiver acknowledging the information is true and releasing the camp of any liabilities that may arise from participation. The form gathers details on family doctor, last medical check-up, any medical problems, surgeries, medications, smoking and drinking habits, recent physical activity, allergies, AD/HD diagnosis, and other conditions to ensure full enjoyment of camp activities.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    4 views1 page

    CCT Camp 2011 Reg Form

    Uploaded by

    Ray Miller
    This registration form collects confidential information including name, address, date of birth, contact details, medical history, previous sports experience, and any physical, emotional, or social conditions. Applicants must sign a waiver acknowledging the information is true and releasing the camp of any liabilities that may arise from participation. The form gathers details on family doctor, last medical check-up, any medical problems, surgeries, medications, smoking and drinking habits, recent physical activity, allergies, AD/HD diagnosis, and other conditions to ensure full enjoyment of camp activities.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    of 1

    REGISTRATION FORM

    (All information is confidential)

    Name.........................................................................................................................
    Address.....................................................................................................................
    Date of birth .............................................................. Age...............................
    Telephone: home...............................work..................... emergency.......
    Email.........................................................................................................................
    Medical history
    Name of family docto:.........Date of last medical check-up...........................
    Do you have any medical problems (asthma, high blood pressure, etc ?)....
    .......
    Have you ever had any surgery? .
    Are you presently on medication?.........................................................................................
    Do you smoke or drink alcohol? (frequency?).......................................................................
    Have you been physically active during the past 3 months?.................................................
    Any allergies?.......................................................................................................................
    Are you diagnosed AD/HD.
    Do you have any previous sports experience?......................................................................
    Do you have any other physical, emotional or social condition that we should know about in
    order for you to fully enjoy participation in this camp?............................................................
    ...............................................................................................................................................
    Waiver
    I acknowledge that the above statements are true and correct to the best of my knowledge. I
    hereby release CARIBBEAN CROSS TRAINING/ Andrew Eligon and all Employees, Agents,
    liabilities that may arise out of my childs or my own participation in the activities, exercise,
    fitness programs and races. By this release, I also acknowledge that if my child or myself
    should have any known health conditions or family history of such conditions, I will consult a
    physician prior to participating in any aquatic and/or fitness program.

    Signature (parent/guardian if under 18).


    ...
    Date

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