Edmonton Wildcats
2014 - Spring Camp Registration

Dates: May 1 - 4, 2014

Registration Info First Name

Last Name

Date of Birth

AB Health Care Number

Position

Last Team Played for

Email

Address

City

Province / State

Cell Phone

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Relationship

Medical History Report

Have you experienced any major illness in the past year? Yes No

If so, what:

Have you experienced any major injuries/surgeries in the past year? Yes No

If so, what:

Have you experienced a concussion or stinger/burner in the past year? Yes No

Do you wear any contact lenses or glasses or a visor? Yes No

Do you have any pins, plates, screws or dental appliances in your body we should be aware of? Yes No

If so, what:

Does your family have any history of illness or heart attack/stroke? Yes No

If so, what:

Are you taking any medications? Yes No

If so, what:

Are you taking any supplements? Yes No

If so, what:

Do you have any allergies? Yes No

If so, what:

Family Doctors Name

Family Doctors Phone Number

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Edmonton Wildcats 2014 - Spring Camp Registration

Edmonton Wildcats
2014 - Spring Camp Registration